PSYCHOTHERAPY 


IUGO  MUNSTERBERG 


PSYCHOTHEEAPY 


RECENT  BOOKS  BY  THE  SAME    AUTHOR 


Psychology  and  Life,   Boston,  1899 

Grundziige  der  Psychologic,  Leipzig,  1900 

American  Traits,  Boston,    1902 

Die  Amerikaner,  Berlin,  1904 

Principles  of  Art  Education,  New  York,  1905 

The  Eternal  Life,  Boston,  1905 

Science  and  Idealism,  Boston,  1906 

Philosophic  der  Werte,  Leipzig,   1907 

On  the  Witness  Stand,  New  York,   1908 

Aus  Deutsch-Amerjka,  Berlin,  1908 

The  Eternal  Values,  Boston,  1909 


PSYCHOTHEEAPY 


BY 


HUGO   MUNSTERBERG 

M.D.,  PH.D.,  LITT.D.,  LL.D. 
PROFESSOR  OF  PSYCHOLOGY  IN  HARVARD  UNIVERSITY 


NEW  YORK 

MOFFAT,  YARD   AND   COMPANY 
1909 


COPYRIGHT,  1909,  BY 
MOFFAT,  YARD  AND  COMPANY 


All  Rights  Reserved 

Published,  April,  1909 
Second  Printing,  May,  1909 
Third  Printing,  August,  1909 


DR.   FRANZ    PFAFF 

PROFESSOR  OF  THERAPEUTICS  IN 
HARVARD  UNIVERSITY 


PREFACE 

THIS  volume  on  psychotherapy  belongs  to  a  series 
of  books  which  I  am  writing  to  discuss  for  a  wider 
public  the  practical  applications  of  modern  psychol- 
ogy. The  first  book,  called  "  On  the  Witness  Stand," 
studied  the  relations  of  scientific  psychology  to  crime 
and  the  law  courts.  This  new  book  deals  with  the 
relations  of  psychology  to  medicine.  Others  dis- 
cussing its  relations  to  education,  to  social  problems, 
to  commerce  and  industry  will  follow  soon. 

For  popular  treatment  I  divide  applied  psychology 
into  such  various,  separated  books  because  they 
naturally  address  very  different  audiences.  That 
which  interests  the  lawyer  does  not  concern  the  physi- 
cian, and  again  the  school-teacher  has  his  own  sphere 
of  interests.  Moreover  the  different  subjects  de- 
mand a  different  treatment.  The  problems  of  psy- 
chology and  law  were  almost  entirely  neglected.  I 
was  anxious  to  draw  wide  attention  to  this  promising 
field  and  therefore  I  chose  the  form  of  loose  popular 
essays  without  any  aim  towards  systematic  presenta- 
tion of  the  subject.  As  to  psychology  and  medicine 
almost  the  opposite  situation  prevails.  There  is  per- 
haps too  much  talk  afloat  about  psychotherapy,  the 
widest  circles  cultivate  the  discussion,  the  magazines 

vii 


viii  PREFACE 

overflow  with  it.  The  duty  of  the  scientific  psychol- 
ogist is  accordingly  not  to  stir  up  interest  in  this  topic 
but  to  help  in  bringing  this  interest  from  mere  gossip, 
vague  mysticism,  and  medical  amateurishness  to  a 
clear  understanding  of  principles.  What  is  needed 
in  this  time  of  faith  cures  of  a  hundred  types  is  to 
deal  with  the  whole  circle  of  problems  in  a  serious, 
systematic  way  and  to  emphasize  the  aspect  of  scien- 
tific psychological  theory. 

Hence  the  whole  first  part  of  this  book  is  an  ab- 
stract discussion  and  its  first  chapters  have  not  even 
any  direct  relation  to  disease.  I  am  convinced  that 
both  physicians  and  ministers  and  all  who  are  in  prac- 
tical contact  with  these  important  questions  ought  to 
be  brought  to  such  painstaking  and  perhaps  fatiguing 
inquiry  into  principles  before  the  facts  are  reached. 
To  those  who  seek  a  discussion  of  life  facts  alone,  the 
whole  first  part  will  of  course  appear  to  be  a  tedious 
way  around ;  they  may  turn  directly  to  the  second  and 
third  parts. 

One  word  for  my  personal  right  to  deal  with  these 
questions,  as  too  much  illegitimate  psychotherapeutics 
is  heard  to-day.  For  me,  the  relation  between  psy- 
chology and  medicine  is  not  a  chance  chapter  of  my 
science  to  which  I  have  turned  simply  in  following  up 
the  various  sides  of  applied  psychology.  And  still 
less  have  I  turned  to  it  because  it  has  become  the 
fashion  in  recent  years.  On  the  contrary,  it  has  been 
an  important  factor  in  all  my  work  since  my  student 
days.  I  have  been  through  five  years  of  regular 
medical  studies,  three  years  in  Leipzig  and  two  years 


PREFACE  ix 

in  Heidelberg;  I  have  an  M.D.  degree  from  the  Uni- 
versity of  Heidelberg.  In  my  first  year  as  decent  in  a 
German  university  twenty  years  ago,  I  gave  through- 
out the  winter  semester  before  several  hundred  stu- 
dents a  course  in  hypnotism  and  its  medical  applica-- 
tion.  It  was  probably  the  first  university  course  on 
hypnotism  given  anywhere.  Since  that  time  I  have 
never  ceased  to  work  psychotherapeutically  in  die 
psychological  laboratory.  Yet  that  must  not  be  mis- 
understood. I  have  no  clinic,  and  while  by  principle 
I  have  never  hypnotized  anyone  for  mere  experi- 
ment's sake  but  always  only  for  medical  purposes,  yet 
I  adjust  my  practical  work  entirely  to  the  interests  of 
my  scientific  study.  The  limitations  of  my  time  force 
me  to  refuse  the  psychotherapeutic  treatment  of  any 
case  which  has  not  a  certain  scientific  interest  for  me, 
and  of  the  many  hundreds  whom  I  have  helped  in  the 
laboratory,  no  one  ever  had  to  pay  anything.  Thus 
my  practical  work  has  strictly  the  character  of  labora- 
tory research. 

The  chief  aim  of  this  book  is  twofold.  It  is  a 
negative  one:  I  want  to  counteract  the  misunder- 
standings which  overflood  the  whole  field,  especially 
by  the  careless  mixing  of  mental  and  moral  influence. 
And  a  positive  one:  I  want  to  strengthen  the  public 
feeling  that  the  time  has  come  when  every  physician 
should  systematically  study  psychology,  the  normal 
in  the  college  years  and  the  abnormal  in  the  medical 
school.  This  demand  of  medical  education  cannot 
be  postponed  any  longer.  The  aim  of  the  book  is 
not  to  fight  the  Emmanuel  Church  Movement,  or 


x  PREFACE 

even  Christian  Science  or  any  other  psychotherapeutic 
tendency  outside  of  the  field  of  scientific  medicine.  I 
see  the  element  of  truth  in  all  of  them,  but  they  ought 
to  be  symptoms  of  transition.  Scientific  medicine 
should  take  hold  of  psychotherapeutics  now  or  a  most 
deplorable  disorganization  will  set  in,  the  symptoms 
of  which  no  one  ought  to  overlook  to-day. 

HUGO  MUNSTERBERG. 
HARVARD  UNIVERSITY,  March  20,  1909. 


CONTENTS 

CHAPTER  PACK 

I.     INTRODUCTION .       I 

PART  I 
THE  PSYCHOLOGICAL    BASIS  OF  PSYCHOTHERAPY 

II.  THE  AIM  OF  PSYCHOLOGY       ....       9 

III.  MIND  AND  BRAIN 27 

IV.  PSYCHOLOGY  AND  MEDICINE     .       .       .       .55 
V.  SUGGESTION  AND  HYPNOTISM   .  .        .85 

VI.    THE  PSYCHOLOGY  OF  THE  SUBCONSCIOUS      .   125 

PART  II 
THE  PRACTICAL  WORK  OF  PSYCHOTHERAPY 

VII.    THE  FIELD  OF  PSYCHOTHERAPY      .       .        .158 
VIII.    THE    GENERAL    METHODS    OF    PSYCHO- 
THERAPY         184 

IX.     THE    SPECIAL    METHODS    OF    PSYCHO- 
THERAPY        212 

X.    THE  MENTAL  SYMPTOMS 239 

XL    THE  BODILY  SYMPTOMS 297 

PART  III 
THE  PLACE  OF  PSYCHOTHERAPY 

XII.     PSYCHOTHERAPY  AND  THE  CHURCH       .       .319 

XIII.  PSYCHOTHERAPY  AND  THE  PHYSICIAN    .        .   347 

XIV.  PSYCHOTHERAPY  AND  THE  COMMUNITY       .  370 


INTRODUCTION 

PSYCHOTHERAPY  is  the  practice  of  treating 
the  sick  by  influencing  the  mental  life.  It 
stands  at  the  side  of  physicotherapy,  which  at- 
tempts to  cure  the  sick  by  influencing  the  body,  per- 
haps with  drugs  and  medicines,  or  with  electricity  or 
baths  or  diet. 

Psychotherapy  is  sharply  to  be  separated  from 
psychiatry,  the  treatment  of  mental  diseases.  Of 
course  to  a  certain  degree,  mental  illness  too,  is 
open  to  mental  treatment;  but  certainly  many  diseases 
of  the  mind  lie  entirely  beyond  the  reach  of  psycho- 
therapy, and  on  the  other  hand  psychotherapy  may 
be  applied  also  to  diseases  which  are  not  mental  at 
all.  That  which  binds  all  psychotherapeutic  efforts 
together  into  unity  is  the  method  of  treatment.  The 
psychotherapist  must  always  somehow  set  levers  of 
the  mind  in  motion  and  work  through  them  towards 
the  removal  of  the  sufferer's  ailment;  but  the  dis- 
turbances to  be  treated  may  show  the  greatest  possible 
variety  and  may  belong  to  mind  or  body. 

Treatment  of  diseases  by  influence  on  the  mind  is 
as  old  as  human  history,  but  it  has  attained  at  various 
times  very  different  degrees  of  importance.  There 
is  no  lack  of  evidence  that  we  have  entered  into  a 


a  PSYCHOTHERAPY 

period  in  which  an  especial  emphasis  will  be  laid  on 
the  too  long  neglected  psychical  factor.  This  new 
movement  is  probably  only  in  its  beginning  and  the 
loudness  with  which  it  presents  itself  to-day  is  one  of 
the  many  indications  of  its  immaturity.  Whether 
it  will  be  a  blessing  or  a  danger,  whether  it  will  really 
lead  forward  in  a  lasting  way,  or  whether  it  will  soon 
demand  a  reaction,  will  probably  depend  in  the  first 
place  on  the  soberness  and  thoroughness  of  the  dis- 
cussion. If  the  movement  is  carried  on  under  the 
control  of  science,  it  may  yield  lasting  results.  If  it 
keeps  the  features  of  dilettanteism  and  prefers  as- 
sociation with  the  antiscientific  tendencies,  it  is  pre- 
destined to  have  a  spasmodic  character  and  ultimately 
to  be  harmful. 

The  chaotic  character  of  psychotherapy  in  this 
first  decade  of  the  twentieth  century  can  be  easily 
understood.  It  results  from  the  fact  thatlm  our 
period  one  great  wave  of  civilization  is  sinking  and  a 
new  wave  rising,  while  the  one  has  not  entirely  dis- 
appeared and  the  other  is  still  far  from  its  height. 
The  history  of  civilization  has  shown  at  all  times  a 
wavelike  alternation  between  realism  and  idealism, 
that  is,  between  an  interest  in  that  which  is,  and  an 
interest  in  that  which  ought  to  be.  In  the  realistic 
periods,  the  study  of  facts,  especially  of  the  facts  of 
nature,  is  prevalent;  in  idealistic  periods,  history  and 
literature  appeal  to  the  world.  In  realistic  periods, 
technique  enjoys  its  triumphs;  in  idealistic  periods, 
art  and  religion  prevail.  Such  a  realistic  movement 
lies  behind  us.  It  began  with  the  incomparable  de- 


INTRODUCTION  3 

velopment  of  physics,  chemistry,  and  biology,  in  the 
middle  of  the  last  century,  and  it  brought  with  it  the 
achievements  of  modern  engineering  and  medicine. 
We  are  still  fully  under  the  influence  of  this  gigantic 
movement  and  its  real  achievements  will  never  leave 
us ;  and  yet  this  realistic  wave  is  ebbing  to-day  and  a 
new  period  of  idealism  is  rising.  If  the  signs  are  not 
deceitful,  this  new  movement  may  reach  its  historical 
climax  a  few  decades  hence,  when  new  leaders  may 
give  to  the  idealistic  view  of  the  world  the  same 
classical  expression  which  Darwin  and  others  gave  to 
the  receding  naturalistic  age.  The  signs  are  clear 
indeed  that  the  days  of  idealistic  philosophy  and  of 
art,  and  of  religion,  are  approaching;  that  the  world 
is  tired  of  merely  connecting  facts  without  asking 
what  their  ultimate  meaning  is.  The  world  dimly 
feels  again  that  technical  civilization  alone  cannot 
make  life  more  worth  living.  The  aim  of  the  last 
generation  was  to  explain  the  world;  the  aim  of  the 
next  generation  will  be  to  interpret  the  world;  the 
one  was  seeking  laws,  the  other  will  seek  ideals.  _____ 
Psychotherapy  stands  in  the  service  of  both;  it  is 
the  last  word  of  the  passing  naturalistic  movement, 
and  yet  in  another  way  it  tries  to  be  the  first  word  of 
the  coming  idealistic  movement;  and  because  it  is 
under  the  influence  of  both,  it  speaks  sometimes  the 
language  of  the  one,  and  sometimes  the  language  of 
the  other.  That  brings  about  a  confusion  and  a  dis- 
order which  must  be  detrimental.  To  transform  this 
vagueness  into  clear,  distinct  relations  is  the  im- 
mediate duty  of  science. 


4  PSYCHOTHERAPY 

Indeed  it  may  be  said  that  psychotherapy  is  the  last 
word  of  a  naturalistic  age,  because  psychotherapy 
finds  its  real  stronghold  in  a  systematic  study  of  the 
mental  laws,  and  such  study  of  mental  laws,  psychol- 
ogy, must  indeed  be  the  ultimate  outcome  of  a 
naturalistic  view  of  the  world.  Realism  begins  with 
the  analysis  of  lifeless  nature,  begins  with  the  study 
of  the  stars  and  the  stones,  of  masses  and  of  atoms. 
At  a  higher  level,  it  turns  then  to  the  living  organism, 
studies  plants  and  animals  and  even  brings  the  human 
organism  entirely  under  the  point  of  view  of  natural 
law.  When  science  has  thus  mastered  the  whole 
physical  universe,  it  finally  brings  even  the  mental  life 
of  man  under  the  naturalistic  point  of  view,  treats 
his  inner  experiences  like  any  outer  objects,  tears  them 
in  pieces,  analyzes  them,  and  studies  them  as  functions 
of  the  nervous  system.  A  scientific  psychology  is 
thus  reached  which  is  the  climax  of  realism,  because  it 
means  that  even  the  ideas  and  emotions  and  volitions 
of  man  are  treated  as  natural  phenomena,  that  their 
causes  are  sought  and  that  their  effects  are  determined, 
that  their  laws  are  found  out.  To  apply  this  real- 
istic knowledge  of  the  mind  in  the  interest  of  therapy 
is  merely  to  use  it  in  the  same  way  in  which  the 
engineer  uses  his  knowledge  of  physics,  when  he 
wants  to  harness  outer  nature.  As  that  is  possible 
only  when  theoretical  science  has  reached  a  certain 
height  of  development,  it  can  indeed  be  said  that 
practical  psychotherapy  on  a  scientific  basis  can  be 
considered  almost  as  the  ultimate  point  of  a  realistic 
movement ;  I  it  cannot  set  in  until  psychology  has 


INTRODUCTION  5 

reached  high  development,  and  psychology  cannot  set 
in  unless  biology  has  preceded  it. 

There  is  no  doubt  that  we  are  still  far  from  this 
last  phase  of  the  realistic  period.  The  practical 
application  of  scientific  psychology  is  still  a  new 
problem.  Experimental  psychology  began  about 
twenty-five  years  ago;  at  that  time  there  existed  one 
psychological  laboratory.  To-day  there  is  no  univer- 
sity in  the  world  which  does  not  have  a  psychological 
workshop.  But  laboratories  for  applied  psychology 
are  only  arising  in  these  present  days,  and  the 
systematic  application  of  scientific  psychology  to 
education  and  law  and  industry  and  social  life  and 
medicine  is  almost  at  its  beginning.  While  the  height 
of  the  last  realistic  wave  was  in  the  period  of  the 
sixties,  seventies,  and  eighties,  of  the  last  century,  its 
last  phase,  the  practical  application  of  physiological 
psychology,  including  psychotherapy,  is  only  at  its 
commencement. 

But  while  this  last  great  movement  has  not  yet 
reached  its  end,  the  new  idealistic  movement  to  come 
has  not  yet  reached  a  clear  self-expression.  A  gen- 
eral philosophical  interest  can  be  felt,  but  a  great 
philosophical  synthesis  seems  still  lacking.  A  new 
sense  of  duty  can  vaguely  be  felt,  but  great  new  tasks 
have  not  yet  found  common  acknowledgment.  Above 
all,  the  unshaped  emotionalism  of  the  masses  has  not 
yet  been  brought  into  any  real  contact  with  the  new 
idealism  which  grows  up  on  the  higher  level  of  schol- 
arly thought.  But  it  is  evident,  if  a  new  great  mood 
of  idealism  is  to  come,  one  of  its  popular  forerunners 


must  be  the  demand  that  the  spirit  is  real  in  a  higher 
sense  than  matter,  that  the  mind  controls  the  body, 
that  faith  can  cure.  In  such  unphilosophic  crudeness, 
no  definite  thought  is  expressed,  as  everything  would 
depend  on  the  definition  of  spirit,  of  faith,  of  mind, 
of  reality.  Moreover,  every  inquiry  would  prove 
that  the  idealistic  value  of  such  statements  as  are 
afloat  among  the  masses  to-day  is  reached  only  by  a 
juggling  with  words.  That  faith  can  cure  appears  to 
point  towards  the  higher  world,  as  the  word  faith  has 
there  the  connotation  of  the  faith  in  a  religious  sense ; 
and  yet  the  faith  which  really  cures  a  digestive 
trouble,  for  instance,  is  the  faith  in  the  final  over- 
coming of  the  intestinal  disturbance,  an  idea  which 
belongs  evidently  in  the  region  of  physiological  psy- 
chology, but  not  in  the  region  of  the  church.  Yet, 
however  clumsy  such  statements  may  be,  they  are 
surely  controlled  by  the  instinctive  desire  for  a  new 
idealistic  order  of  our  life,  and  the  time  will  come 
when  their  unreasoning  and  unreasonable  wisdom  will 
be  transformed  into  sound  philosophy  without  losing 
its  deepest  impulse.  The  realistic  conviction  that  even 
the  mind  is  completely  controlled  by  natural  laws  and 
the  idealistic  inspiration  that  the  mind  of  man  has  in 
its  freedom  mastery  over  the  body,  are  thus  most 
curiously  mixed  in  the  popular  psychotherapy  of  the 
day,  and  too  few  recognize  that  the  real  meaning  of 
mind  is  an  entirely  different  one  in  these  two  proposi- 
tions. 

Of  course  the  one  or  the  other  of  these  two  ele- 
ments prevails  in  the  systematic  treatises  on  the  sub- 


INTRODUCTION  7 

ject;  the  realistic  one  in  those  written  by  the  psy- 
chiatrists, the  idealistic  one  in  those  written  by  clergy- 
men or  Christian  Scientists.  The  literature  indeed  is 
almost  entirely  supplied  from  these  two  quarters :  and 
yet  it  is  evident  that  neither  the  one  nor  the  other 
party  can  give  to  the  problem  its  most  natural  setting. 
The  student  of  mental  diseases  naturally  emphasizes 
the  abnormal  features  of  the  situation,  and  thus 
brings  the  psychotherapeutic  process  too  much  into 
the  neighborhood  of  pathology.  Psychotherapy  be- 
came in  such  hands  essentially  a  study  of  hypnotism, 
with  especial  interest  in  its  relation  to  hysteria  and 
similar  diseases.  The  much  more  essential  relation 
of  psychotherapy  to  the  normal  mental  life,  the  re- 
lation of  suggestion  and  hypnotism  to  the  normal 
functions  seemed  too  often  neglected.  Whoever 
wants  to  influence  the  mind  in  the  interest  of  the 
patient,  must  in  the  first  place  be  in  intimate  contact 
with  psychology.  On  the  other  hand,  the  minister's 
spiritual  interest  brings  the  facts  nearer  to  religion 
than  they  really  are.  That  a  suggestion  to  get  rid 
of  toothache,  or  to  sleep  the  next  night,  is  given  by  a 
minister,  does  not  constitute  it  as  a  religious  sug- 
gestion. If  the  belief  in  religion  simply  lies  along- 
side of  the  belief  in  most  trivial  effects,  and  both  are 
applied  in  the  same  way  for  curing  the  sick,  it  is  evi- 
dent that  not  the  spiritual  meaning  of  religion  is 
responsible  for  the  cure,  but  the  psychological  process 
of  believing.  But  if  that  is  the  case,  it  is  clear  that 
here  again  the  psychologist,  and  not  the  moralist,  will 
give  the  correct  account  of  the  real  process  involved. 


8  PSYCHOTHERAPY 

In  short,  it  is  psychology,  psychology  in  its  scientific 
modern  form,  which  has  to  furnish  the  basis  for  a  full 
understanding  of  psychotherapy.  From  psychology 
it  cannot  be  difficult  to  bridge  over  to  the  medical 
interests,  on  the  one  side,  to  the  idealistic  ones  on  the 
other  side. 

Our  task  here  is,  therefore,  to  lay  a  broad  psycho- 
logical foundation.  We  must  carefully  inquire  how 
the  modern  psychologist  looks  on  mental  life  and 
how  the  inner  experiences  appear  from  such  a  psy- 
chological standpoint.  The  first  chapters  of  this 
volume  may  appear  like  a  long,  tiresome  way  around 
before  we  come  to  our  goal,  the  study  of  the  psy- 
chotherapeutic  agencies.  And  yet  it  is  the  only  pos- 
sible way  to  overcome  the  superficiality  with  which 
the  discussion  is  too  often  carried  on;  we  must  under- 
stand exactly  how  the  psychological  analysis  and  ex- 
planation of  the  scientist  differ  from  the  popular 
point  of  view.  After  studying  in  this  spirit  the  foun- 
dation of  psychotherapy,  we  shall  carefully  examine 
the  practical  work,  its  methods  and  its  results,  its  pos- 
sibilities and  its  limitations.  We  shall  inquire  finally 
into  the  place  which  it  has  to  take,  looking  back  upon 
its  history,  criticising  the  present  status  and  outlining 
the  development  which  has  to  set  in  for  the  future,  if 
a  haphazard  zigzag  movement  is  not  to  destroy  this 
great  agency  for  human  welfare  by  transforming  it 
into  a  source  of  superstition  and  bodily  danger. 


e/ 


PARTI 

THE  PSYCHOLOGICAL  BASIS  OF  PSYCHO- 
THERAPY 

II 

THE  AIM  OF  PSYCHOLOGY 

THE  only  safe  basis  of  psychotherapy  is  a 
thorough  psychological  knowledge  of  the 
human  personality.  Yet  such  a  claim  has 
no  value  until  it  is  entirely  clear  what  is  meant  by 
psychological  knowledge.  We  can  know  man  in 
many  ways.  Not  every  study  of  man's  inner  life  is 
psychology  and  the  careless  mixing  of  different  ways 
of  dealing  with  man's  inner  life  is  largely  responsible 
for  the  vagueness  which  characterizes  the  popular 
literature  of  psychotherapy.  It  is  not  enough  to  say 
that  a  statement  is  true  or  not  true.  It  may  be  true 
under  one  aspect  and  entirely  meaningless  under 
another.  For  instance,  a  minister's  discussion  of 
man's  energies  may  be  full,  of  deep  truth  and  may 
be  inspiring;  and  yet  it  may  not  contain  the  slightest 
contribution  to  a  really  psychological  knowledge  of 
those  energies,  and  would  mislead  entirely  the  physi- 
cian were  he  to  base  his  treatment  of  human  energies 
on  such  a  religious  interpretation. 

Can  we  not  look  from  different  standpoints  even 

9 


io  PSYCHOTHERAPY 

on  any  part  of  the  outer  world?  I  see  before  me  the 
ocean  with  its  excited  waves  splashing  against  the 
rocks  and  shore,  I  see  the  boats  tossed  on  the  stormy 
sea  and  I  am  fascinated  by  the  new  and  ever  new 
impulses  of  the  tumultuous  waves.  The  whole  ap- 
pears to  me  like  one  gigantic  energy,  like  one  great 
emotional  expression,  and  I  feel  deeply  how  I  under- 
stand this  beautiful  scenery  in  appreciating  its  unity 
and  its  meaning.  Yet  would  I  ever  think  that  it  is 
the  only  way  to  understand  this  turmoil  of  the  waters 
before  me  ?  I  know  there  is  no  unity  and  no  emotion 
in  the  excited  sea ;  each  wave  is  composed  of  hundreds 
of  thousands  of  single  drops  of  water,  and  each  drop 
composed  of  billions  of  atoms,  and  every  movement 
results  from  mechanical  laws  under  the  influence  of 
the  pressing  water  and  air.  There  is  hydrogen  and 
there  is  oxygen,  and  there  is  chloride  of  sodium,  and 
the  dark  blue  color  is  nothing  but  the  reflection  of 
billions  of  ether  vibrations.  But  have  I  really  to 
choose  between  two  statements  concerning  the  waves, 
one  of  which  is  valuable  and  the  other  not?  On  the 
contrary,  both  have  fundamental  value.  If  I  take 
the  attitude  of  appreciation,  it  would  be  absurd  to  say 
that  this  wave  is  composed  of  chemical  elements 
which  I  do  not  see;  and  if  I  take  the  attitude  of 
physical  explanation,  it  would  be  equally  absurd  to 
deny  that  such  elements  are  all  of  which  the  wave  is 
made.  From  the  one  standpoint,  the  ocean  is  really 
excited;  from  the  other  standpoint,  the  molecules  are 
moving  according  to  the  laws  of  hydrodynamics.  If 
I  want  to  understand  the  meaning  of  this  scene  every 


THE  AIM  OF  PSYCHOLOGY          n 

reminiscence  of  physics  will  lead  me  astray;  if  I  want 
to  calculate  the  movement  of  my  boat,  physics  alone 
can  help  me. 

As  long  as  we  deal  with  outer  nature,  there  is 
hardly  a  fear  of  confusing  the  various  attitudes;  but 
it  becomes  by  far  more  complex  when  we  deal  with 
man  and  his  inner  life.  We  might  abstract  entirely 
from  aesthetic  appreciation  or  from  moral  valuation, 
we  might  take  man  just  as  an  object  of  knowledge; 
and  yet  what  we  know  about  him  may  be  entirely 
different  in  accordance  with  our  special  attitude. 
Each  kind  of  knowledge  may  be  entirely  true,  and 
yet  true  only  from  the  particular  standpoint.  Let  us 
consider  two  extremes.  If  I  meet  a  friend  and  we 
enter  into  a  talk,  I  try  to  understand  his  thoughts  and 
to  share  his  views.  I  agree  or  disagree  with  him;  I 
sympathize  with  his  feelings,  I  estimate  his  purposes. 
In  short,  he  is  for  me  a  center  of  aims  and  intentions 
which  I  interpret:  he  comes  in  question  for  me  as  a 
self  which  has  its  meaning  and  has  its  unity.  The 
more  I  am  interested  in  his  opinions,  the  more  I  feel 
in  every  utterance,  in  every  gesture,  the  expression  of 
his  will  and  his  purposes ;  their  whole  reality  for  me 
lies  in  the  fact  that  they  point  to  something  which 
the  speaker  intends ;  his  personality  lies  in  his  attitude 
towards  the  surroundings,  towards  the  world.  Yet 
I  may  take  an  entirely  different  relation  to  the  same 
man.  I  may  ask  myself  what  processes  are  going  on 
in  his  mind,  what  are  the  real  contents  of  his  con- 
sciousness, that  is,  what  perceptions  and  memory 
pictures  and  imaginative  ideas  and  feelings  and 


12  PSYCHOTHERAPY 

emotions  and  judgments  and  volitions  are  really  pres- 
ent in  his  consciousness.  I  watch  him  to  find  out,  I 
observe  his  mental  states,  I  do  not  ask  whether  I 
agree  or  disagree ;  his  will  is  for  me  now  not  something 
which  has  a  meaning,  but  simply  something  which 
occurs  in  his  inner  experience;  his  ideas  now  have  for 
me  no  reference  to  something  in  the  world,  but  they 
are  simply  contents  of  his  consciousness ;  his  memories 
now  are  for  me  not  symbols  of  a  past  to  which  he 
refers,  but  they  are  present  pictures  in  his  mind;  in 
short,  what  I  now  find  is  not  a  self  which  shows 
itself  in  its  aims  and  purposes  and  attitudes,  but  a 
complex  content  of  consciousness  which  is  composed 
of  numberless  elements.  I  might  say  in  the  first  place 
that  my  friend  was  to  me  a  subject  whom  I  tried 
to  understand  by  interpreting  his  meaning,  and  in 
the  second  case,  an  object  which  I  understand  by 
describing  its  structure,  its  elements,  and  their 
connections. 

Both  ways  of  looking  on  man  are  constantly 
needed.  We  might  alternate  between  them  in  any 
experience.  In  the  heat  of  argument,  my  friend  will 
certainly  be  for  me  the  subject  with  whose  meanings  I 
try  to  agree  or  disagree,  whose  emotions  carry  me 
away,  whose  ideas  open  the  world  to  me.  Yet  in 
the  next  moment,  I  may  notice  that  his  ideas  were 
shaped  and  determined  by  certain  earlier  experiences ; 
that  they  linked  themselves  in  memory  according  to 
certain  laws  of  mental  flow;  that  the  vividness  of  his 
ideas  made  him  overlook  certain  impressions  of  the 
surroundings;  and  that  may  turn  my  attention  to  an 


THE  AIM  OF  PSYCHOLOGY  13 

entirely  different  aspect  of  his  inner  life.  His  feel- 
ings and  emotions,  his  volitions  and  judgments  now 
have  for  me  simply  the  character  of  processes  which 
go  on  and  which  are  observed,  which  coincide  and 
which  succeed  each  other,  which  fuse  and  overlap, 
and  which  are  composed  of  smaller  parts.  My  in- 
terest is  now  no  longer  in  the  meaning  and  intentions 
of  this  self,  but  it  belongs  to  the  structure  and  the  con- 
nections in  this  system  of  mental  facts.  At  first,  I 
wanted  to  understand  him  by  living  with  him,  by 
participating  in  his  attitudes,  and  by  feeling  with  his 
will ;  now  I  want  to  understand  him  by  examining  all 
the  processes  which  go  on  in  his  consciousness,  by 
studying  their  make-up  and  their  behavior,  their  ele- 
ments and  their  laws.  In  one  case  I  wanted  to  inter- 
pret the  man,  and  finally  to  appreciate  him;  in  the 
other  case  I  wanted  to  describe  his  inner  life,  and 
finally  to  explain  it.  The  man  whose  inner  life  I 
want  to  share  I  treat  as  a  subject,  the  man  whose 
inner  life  I  want  to  describe  and  explain  I  treat  as  an 
object. 

I  might  express  these  two  standpoints  still  other- 
wise. If  my  neighbor  is  to  me  a  subject,  for  instance, 
in  the  midst  of  an  ordinary  conversation,  he  comes  in 
question  only  with  reference  to  his  aims  and  mean- 
ings: whatever  he  utters  has  a  purpose  and  end.  I 
understand  his  inner  life  by  taking  a  purposive  point 
of  view.  On  the  other  hand,  the  man  whose  inner 
life  is  to  me  an  object  can  satisfy  my  interest  only  if 
I  understand  every  particular  happening  in  his  mind 
from  its  preceding  causes.  I  transform  his  whole  life 


i4  PSYCHOTHERAPY, 

into  a  chain  of  causes  and  effects.  My  standpoint  is 
thus  a  causal  one.  No  doubt  in  our  daily  life,  our 
purposive  interest  and  our  causal  interest  may  inter- 
twine at  any  moment.  I  may  sympathize  with  the 
hopes  and  fears  of  my  neighbor  in  a  purposive  way, 
and  may  yet  in  the  next  moment  consider  from  a 
causal  standpoint  how  these  emotions  of  his  are  per- 
haps affected  by  his  fatigue  or  by  some  glasses  of  wine, 
or  by  a  hereditary  disposition,  or  by  a  suggestion ;  in 
short,  at  one  time  I  look  out  for  the  meaning  of  the 
emotion  as  a  part  of  the  expression  of  a  self,  and  at 
another  time  for  the  structure  and  appearance  of  the 
emotion  as  a  part  of  a  causal  chain  of  events.  In 
both  directions  I  can  go  on  with  entire  consistency, 
and  there  cannot  be  any  part  of  inner  experience 
which  cannot  be  fully  brought  under  either  point  of 
view.  How  far  we  have  a  right  to  mix  the  two 
standpoints  in  practical  life,  we  shall  carefully  ex- 
amine; but  it  is  clear  that  if  we  want  to  understand 
the  true  meaning  of  the  study  of  inner  life,  we  have 
no  longer  any  right  carelessly  to  mix  the  two  stand- 
points without  being  conscious  of  their  fundamental 
difference.  We  must  understand  exactly  what  the 
aim  of  the  one  and  of  the  other  is,  and  where  each  has 
its  particular  value;  science  certainly  has  no  right  to 
throw  together  such  different  views  of  life.  And 
now  this  may  be  said  at  once:  the  causal  view  only 
is  the  view  of  psychology;  the  purposive  view  lies 
outside  of  psychology. 

Such  a  separation  does  not  at  all  aim  to  indicate 
that  the  one  view  is  more  important  than  the  other, 


THE  AIM  OF  PSYCHOLOGY  15 

or  that  the  one  has  more  scientific  dignity  than  the 
other;  both  yield  us  truth,  and  both  may  be  carried 
from  the  simplest  and  most  trivial  observations  of 
daily  life  to  the  highest  elaborations  of  scholarship. 
To  those  who  are  inclined  to  give  all  value  and  all 
credit  only  to  the  strictly  psychological  view,  it  may 
be  replied  at  once  that  surely  our  most  immediate  life 
experience  is  carried  on  by  the  non-psychological  atti- 
tude. If  we  love  our  family  and  like  our  friends, 
and  deal  with  the  man  of  the  street,  we  are  certainly 
moving  in  a  world  of  purposive  reality.  We  try  to 
understand  each  other,  to  agree  and  to  disagree,  to  be 
in  sympathy  and  antipathy,  without  asking  how  those 
volitions  and  feelings  and  ideas  of  other  people  are 
built  as  mental  structures,  and  from  what  causes  they 
arose;  we  are  satisfied  to  understand  what  they  mean. 
In  the  same  way  with  ourselves.  We  live  our  lives 
by  hinging  them  on  our  aims  and  purposes  and  ideas, 
and  do  not  ask  ourselves  what  are  the  causes  of  our 
attitudes  and  of  our  thoughts. 

This  purposive  view  has  in  no  respect  to  disappear 
if  we  move  on  from  our  personal  intercourse  to  a 
scholarly  study  of  reality.  The  historian,  for  in- 
stance, who  tries  to  understand  the  will  relations  of 
humanity,  is  the  more  the  true  historian  the  more  he 
sticks  to  this  purposive  view  of  man.  The  truth 
which  he  seeks  is  to  interpret  the  personalities,  to 
understand  them  through  their  attitudes,  to  make 
their  will  living  once  more,  and  to  link  it  by  agree- 
ment and  disagreement,  by  love  and  hate,  with  the 
will  of  friends  and  enemies,  groups  and  parties, 


1 6  PSYCHOTHERAPY 

nations  and  mankind.  It  is  only  a  loose  popular 
way  of  speaking,  if  this  purposive  analysis  of  a  char- 
acter is  often  called  psychological.  In  a  stricter 
sense  of  the  word,  it  is  not  psychological.  If  the 
historian  really  were  to  take  the  psychological  atti- 
tude, he  would  make  of  history  simply  a  social  psy- 
chology, seeking  the  laws  of  the  social  mind,  and 
treating  the  individual,  the  hero,  and  the  leader, 
merely  as  the  crossing-point  of  psychological  law. 
For  such  a  psychological  view  the  mental  life  of  the 
hero  would  not  be  more  important  or  more  interesting 
than  the  mental  life  of  a  scoundrel,  and  the  psychol- 
ogy of  the  king  would  not  draw  his  interest  more  than 
the  psychology  of  the  beggar.  The  historian  has  to 
shape  all  that  from  an  entirely  different  standpoint: 
his  scientific  interest  depends  upon  the  importance  of 
men's  attitudes  and  actions,  and  such  importance 
refers  to  the  world  of  purposes. 

In  the  same  way,  we  have  to  stick  to  the  non-psy- 
chological point  of  view  whenever  man's  life,  his 
thoughts  and  feelings  and  volitions,  are  to  be  meas- 
ured with  reference  to  ideals;  that  is  in  ethics  and 
aesthetics  and  logic,  sciences  which  ask  whether  the 
volitions  are  good  or  bad,  whether  the  feelings  are 
valuable  or  worthless,  whether  the  thoughts  are  true 
or  false.  The  psychologist  does  not  care ;  just  as  the 
botanist  is  interested  in  the  weed  as  much  as  in  the 
flower,  the  pychologist  is  interested  in  the  causal  con- 
nections of  the  most  heinous  crime  not  less  than  in 
those  of  the  noblest  deed,  in  the  structure  of  the  most 
absurd  error  not  less  than  in  that  of  the  maturest 


THE  AIM  OF  PSYCHOLOGY  17 

wisdom.     Truth,  beauty,  and  morality  are  thus  ex- 
pressions of  the  self  in  its  purposive  aspect. 

We  can  go  one  step  further.  Those  who  nar- 
rowly seek  every  truth  only  in  the  scientific  under- 
standing, ought  to  be  reminded  that  this  seeking  for 
causal  connections  is  itself,  after  all,  only  a  life  ex- 
perience which  as  such  is  not  of  causal  but  of  pur- 
posive character.  "  Life  is  bigger  than  thought."  In 
the  immediate  reality  of  our  purposive  life  we  aim 
towards  mastering  the  world  by  a  causal  understand- 
ing, and  for  this  end  we  create  science;  but  this  aim 
itself  is  then  a  purpose  and  not  an  object.  The  first 
act  is  thus  for  us,  the  thinkers,  not  a  part  of  the  causal 
events,  but  a  purposive  intention  towards  an  ideal. 
Therefore,  our  purposes  have  the  first  right;  they 
represent  the  fundamental  reality;  the  value  of  causal 
connections  and  thus  of  all  scientific  and  psycholog- 
ical explanation,  depends  on  the  value  of  the  pur- 
pose. Causal  truth  can  be  only  the  second  word; 
the  first  word  remains  to  purposive  truth.  From  this 
point  of  view  we  may  understand  why  there  is  no  con- 
flict between  the  most  consistent  causal  explanation 
of  mental  life  on  the  one  side,  and  an  idealistic  view 
of  life  on  the  other  side;  yes,  we  can  see  that  the 
fullest  emphasis  on  a  scientific  psychology — which  is 
necessarily  realistic  and,  to  a  certain  degree,  material- 
istic— is  fully  embedded  in  an  idealistic  philosophy  of 
life,  and  that  without  conflict.  And  we  shall  see  how 
this  consistency  in  sharply  separating  the  psycho- 
logical view  from  the  non-psychological,  secures  much 
greater  safety  for  true  idealism  than  the  inconsistent 


1 8  PSYCHOTHERAPY 

popular  mixing  of  the  two  principles,  where  scientific 
psychology  is  constantly  encroached  upon  by  demands 
of  faith  and  religion,  and  where  faith  and  religion 
seem  constantly  in  danger  of  being  overturned  by  new 
discoveries  in  physiological  psychology.  We  may, 
indeed,  remove  from  the  start  the  mistaken  fear  that 
a  consistent  causal  aspect  of  life  leads  to  injustice  to 
the  higher  aims  and  ideal  purposes  of  mankind.  If 
we  want  to  have  psychology, — and  that  means  if  we 
want  to  consider  the  mental  life  in  a  system  of  causes 
and  effects, — we  must  proceed  without  prejudices,  and 
without  side-thoughts. 

From  a  psychological  standpoint  our  own  mental 
life  and  that  of  our  neighbor,  that  of  the  man  and  that 
of  the  child,  that  of  the  normal  and  that  of  the  insane, 
that  of  the  human  being  and  that  of  the  animal,  are 
to  be  considered  as  a  series  of  mental  objects.  They 
are  to  be  analyzed,  and  to  be  described,  and  to  be 
classified  and  to  be  explained,  just  as  we  deal  with 
the  physical  objects  in  the  outer  world.  How  are 
these  objects  of  the  psychologist  different  from  the 
objects  of  the  physicist,  from  the  pebbles  on  the  way 
and  the  stars  in  the  sky?  There  is  only  one  funda- 
mental difference  and  all  other  differences  result  from 
it.  Those  outer  objects  which  we  call  physical,  are 
objects  for  everybody.  The  star  which  I  see  is  con- 
ceived as  the  same  star  which  you  see,  the  table  which 
I  touch  is  the  table  which  you  may  grasp,  too.  But 
every  psychical  object  is  an  object  for  one  particular 
person  only.  My  visual  impression  of  the  star,  that 
is,  my  optical  perception,  is  a  content  of  my  own 


THE  AIM  OF  PSYCHOLOGY  19 

consciousness  only,  and  your  impression  of  the  star  can 
be  a  content  of  your  consciousness  only.  We  both 
may  mean  the  same  by  our  ideas,  but  I  can  never  have 
your  perception  and  you  can  never  have  my  per- 
ception. My  ideas  are  enclosed  in  my  mind.  I  may 
awaken  in  your  mind  ideas  which  have  the  same  pur- 
pose and  meaning,  but  they  are  new  copies  in  your 
mind.  We  both  may  be  angry,  but  your  anger  can 
never  be  my  anger,  and  your  volitions  can  never  enter 
my  mind.  Every  possible  psychical  fact  thus  exists 
in  one  consciousness  only,  while  every  physical  fact 
exists  for  every  possible  consciousness. 

The  psychologist's  final  task  is  to  explain  the  ap- 
pearance and  disappearance,  the  connections  and  se- 
quences of  these  mental  objects,  the  contents  of  con- 
sciousness. But  before  he  can  start  on  explanation  of 
the  facts,  he  has  to  describe  them,  and  describing 
means  analyzing  them  into  their  elements  and  fixating 
those  elements  and  their  combinations  for  an  exact 
report.  Such  descriptive  work  is  in  a  way  prepara- 
tory for  the  further  task  of  real  explanation;  yet  it 
is  in  itself  important,  complicated,  and  difficult.  Of 
course,  it  may  be  easy  to  separate  the  complex  content 
into  some  big  groups  of  facts,  to  point  out  that  this  is 
a  memory  idea  and  this  an  imaginative  idea  and  the 
other  an  abstract  idea,  and  this  a  perception  and  that 
a  feeling,  this  an  emotion  and  that  a  volition.  But 
such  clumsy  first  discrimination  does  not  go  further, 
perhaps,  than  does  the  naturalist's,  who  tells  us  that 
this  is  a  mountain  and  that  a  tree,  this  a  pond  and  that 
a  bird.  The  real  description  would  demand,  of  course, 


20  PSYCHOTHERAPY 

an  exact  measurement  of  the  height  of  the  mountain 
and  the  geological  analysis  of  its  structure,  or  an 
exact  classification  of  the  tree  and  the  bird,  with  a 
complete  description  of  their  organs,  and  in  each 
organ  the  various  tissues  have  to  be  described,  and  in 
each  tissue  the  various  cells,  and  the  microscopist  goes 
further  and  describes  the  structure  of  the  cell.  Cer- 
tainly in  the  same  way  the  psychologist  has  to  go  on 
to  resolve  every  one  of  those  complex  structures; 
he  has  to  examine  the  mental  tissues  and  the  mental 
cells  of  which  a  volition  or  a  memory  idea  or  a  per- 
ception are  composed.  And  while  he  cannot  use  a 
microscope  for  these  mental  elements,  yet  his  studies 
may  cause  elements  to  appear  which  the  nai've  ob- 
servation remains  entirely  unaware  of. 

Perhaps  he  finds  in  his  consciousness  the  perception 
of  the  table  before  him  which  lingers  for  a  little  while 
in  his  mind.  He  finds  no  difficulty  in  analyzing  it 
into  color  sensations  and  tactual  sensations;  and  yet 
he  is  aware  of  so  much  more  in  it.  The  table,  for 
instance,  has  form  for  him  and  he  may  find  that  these 
form  perceptions  involve  the  sensations  of  the  eye 
movements  which  he  makes  from  one  corner  of  the 
table  to  the  other;  he  may  find  that  if  the  idea  lasts 
in  him,  he  becomes  aware  of  the  time  by  sensations  of 
tension;  he  finds  that  in  his  perception  of  the  table 
lies  an  idea  of  its  use,  and  he  discovers  that  that  is 
made  up  of  elements  which  are  partly  memory  repro- 
ductions of  earlier  impressions,  partly  sensations  of 
movement  impulses;  he  also  finds  that  the  table  feels 
smooth,  and  he  discovers  by  his  analysis  that  this  im- 


THE  AIM  OF  PSYCHOLOGY          21 

pression  of  smoothness  results  from  a  special  combi- 
nation of  tactual  sensations  and  movement  sensations; 
and  again  those  movement  sensations  he  analyzes 
further  into  sensations  of  muscle  contraction  and  sen- 
sations of  pressure  in  the  joints  and  sensations  of 
tension  in  the  tendons.  Before  a  zoologist  has  com- 
pleted his  description  of  a  bird  in  the  landscape,  he 
has  given  account  of  hundreds  of  thousands  of  things; 
but  before  the  psychologist  would  complete  the  enu- 
meration of  the  mental  elements  which  enter  into  the 
seeing  of  the  table,  he  would  have  to  give  account  of 
by  far  more  psychical  elements.  Every  point  in  the 
surface  of  the  table  has  its  own  light  value,  perhaps 
different  in  its  quality  and  intensity  and  saturation,  in 
its  hue  and  tint  and  shade  from  the  next  one,  and  at 
whatever  point  of  the  table's  edge  our  attention  is 
directed,  each  one  involves  numberless  shades  in  the 
vividness  of  all  the  other  points  and  numberless 
mental  relations  of  space  perception  among  the  vari- 
ous parts  of  the  table.  In  the  thorough  analysis  of 
the  describing  psychologist,  every  single  idea,  and  in 
the  same  way,  every  single  emotion  or  feeling  or 
judgment  becomes  complex  like  a  living  organism,  an 
aggregate  of  thousands  of  mental  tissues,  and  yet 
made  up  from  "  the  stuff  that  dreams  are  made  of." 
But  there  is  one  particular  difficulty  which  makes 
the  psychological  description  so  much  harder  than 
that  of  the  physicist,  and  which  gives  rise  to  many  dis- 
agreements and  discussions  in  psychological  literature. 
The  psychologist  has  not  only  to  tear  the  complex 
into  pieces  and  thus  to  seek  the  elements,  but  he  has  to 


22  PSYCHOTHERAPY 

fixate  those  elements  for  the  purpose  of  communica- 
tion, as,  of  course,  a  scientific  description  demands 
that  he  be  able  to  give  account  to  others  of  what  he 
experiences.  The  physicist  has  no  difficulty  what- 
ever in  that  line  because,  as  we  saw,  the  world  of 
physical  things  is  the  world  which  all  men  are  sharing 
together.  Every  element  which  I  find  in  it,  I  can 
show  to  every  other  person,  and  if  I  cannot  show  that 
particular  thing,  because  I  cannot  yet  carry  the  moun- 
tain to  another  place,  then  I  can  at  least  measure  it, 
as  we  share  those  standards  of  space.  Thus  natural 
science  has  in  its  objective  measurements  the  possi- 
bility of  describing  every  part  of  the  physical  world. 
The  psychical  world,  on  the  other  hand,  is  as  we  saw, 
the  world  which  is  private  property.  Every  effort  , 
at  description  is  thus  entirely  in  vain  as  long  as  our 
mental  facts  cannot  somehow  be  linked  with  physical 
happenings.  If  I  say  that  I  have  in  my  mind  sweet- 
ness or  sourness,  or  bitterness  or  saltness,  I  cannot 
carry  any  understanding  to  anyone  else  and  there- 
fore cannot  give  any  description  until  I  have  agreed 
that  I  mean  by  sweetness  the  sensation  which  sugar 
gives  me,  and  by  saltness  the  sensation  of  salt.  The 
sugar  and  salt  I  can  point  out  to  my  neighbor  and 
only  in  that  way  I  understand  what  he  means  if  he 
says  that  he  tastes  salt  and  sweet ;  otherwise  I  should 
have  no  means  whatever  to  discriminate  whether  that 
which  he  calls  a  sweet  taste  sensation  is  not  just  what 
I  call  headache.  Where  no  such  direct  relation  for 
a  physical  thing  is  known,  description  of  the  mental 
element  would  remain  impossible.  Of  course,  every 


THE  AIM  OF  PSYCHOLOGY          23 

perception  of  the  outer  world,  all  our  seeing  and  hear- 
ing, and  touching  and  tasting,  offers  us  at  once  such 
definite  connection  between  the  inner  experience  and 
a  piece  of  the  physical  universe.  Our  own  organism  is 
also  such  a  piece  of  physical  nature :  just  as  I  describe 
my  tasting  or  touching,  I  may  describe  the  perception 
of  my  arms  and  legs  or  my  inner  organs.  Thus  every- 
thing which  is  material  of  perception  gives  us  a 
handle  for  a  real  psychological  description.  Psy- 
(  chology  usually  calls  the  elements  of  these  percep- 
tions sensations.  Whatever  is  composed  of  sensa- 
tions is  thus  describable. 

On  the  other  hand,  no  other  way  of  description  is 
open.  If  there  were  mental  states  which  are  com- 
posed of  other  elements  than  sensations,  they  would 
necessarily  remain  indescribable;  we  could  not  grasp 
them  because  they  would  not  have  any  definite  re- 
lation to  the  common  physical  world.  We  might 
say,  for  instance,  that  our  mental  content  is  made  up 
of  sensations  and  feelings,  but  if  such  feelings  were 
really  entirely  different  from  sensations,  they  would 
have  to  remain  for  all  time  mysterious  and  unknown. 
We  could  not  compare  notes.  The  feeling  which  I 
call  joy  may  feel  just  like  the  one  which  you  call 
despair.  The  consistent  development  of  modern  psy- 
chology and  its  emancipation  from  vagueness  and 
superficial  analysis  became  possible  only  through  the 
fact  that  such  recourse  to  indescribable  elements  has 
become  unnecessary.  Modern  psychology  has  been 
able  to  demonstrate  more  and  more  that  the  same 
elements  which  constitute  our  perceptions  are  also  the 


24  PSYCHOTHERAPY 

elements  of  the  other  contents  of  consciousness.  In 
other  words  modern  psychology  has  recognized  that 
the  volitions  and  emotions  and  feelings  and  judg- 
ments, and  the  whole  stream  of  inner  life,  are  made 
up  of  sensations.  Millions  of  sensations  in  all  de- 
grees of  vividness  and  clearness,  of  intensity  and 
fusion,  in  endless  manifoldness  of  rhythms  and  re- 
lations constitute  their  whole  content.  It  is  a  dis- 
covery quite  similar  to  the  one  which  chemistry  made 
when  it  found  that  the  same  elements  which  are  part 
of  the  inorganic  substances  are  also  the  only  possible 
elements  of  the  organic  world. 

From  a  strictly  psychological  standpoint,  the  ideas 
and  the  not-ideas  contain  thus  nothing  but  sensations. 
Their  grouping,  their  shading,  their  combination, 
their  succession  decide  whether  we  have  before  us  a 
perception  or  an  imagination,  a  volition  or  an  emo- 
tion. What  are  we  ourselves  then  for  the  psychol- 
ogist? Evidently  we  ourselves  belong  also  to  the  in- 
ner experiences  which  we  know;  and  psychology  has 
succeeded  in  analyzing  this  idea  of  our  own  self  just 
in  the  same  way  as  it  analyzes  our  idea  of  the  moon. 
In  this  analysis,  psychology  finds  its  idea  of  the  self 
as  a  content  of  consciousness  crystallized  about  the 
sensations  from  the  body.  Every  one  of  our  bodily 
activities  is  represented  in  our  consciousness  by  move- 
ment sensations,  and  these  sensations  form  the  core 
of  the  complex  aggregate  which  develops  into  the 
idea  of  ourselves.  Organic  sensations  from  our  in- 
ner organs,  pain  sensations  and  pleasure  sensations 
fuse  with  the  movement  sensations,  and  the  whole 


THE  AIM  OF  PSYCHOLOGY          25 

complex  shapes  itself  slowly  into  the  idea  of  the 
personality  of  the  self  in  contrast  to  the  idea  of  other 
personalities.  We  ourselves  are  for  ourselves  a 
complex  combination  of  sensations;  and  yet  all  our 
feelings  and  emotions  and  volitions  are  only  a  part  of 
it.  Psychology  thus  necessarily  considers  those  ex- 
periences of  feeling  and  will  and  character  simply  as 
changes  in  the  midst  of  that  central  experience  of  per- 
sonality which  is  itself  made  up  of  bodily  sensations. 
Each  bit  of  will  and  emotion  must  be  decomposed 
into  its  finest  elements.  There  is  no  passing  mood, 
and  no  floating  half-thought  in  our  mind,  no  dream 
and  no  intuition,  no  slightest  change  of  attention, 
no  instinct  and  desire  which  cannot  be  analyzed 
thus  into  its  sensation  elements  or  rather  which  must 
not  be  analyzed,  if  we  are  to  describe  it  at  all,  and 
that  means  if  we  are  to  give  a  psychological  ac- 
count. Psychology  is  endlessly  far  from  this  ideal 
to-day.  It  has  been  claimed,  not  without  justice, 
that  psychology  has  reached  to-day  only  the  level 
which  physics  attained  in  the  seventeenth  century; 
but  psychology  must  insist  that  its  ideal  lies  in 
this  direction.  No  one  takes  a  real  psychological 
view  of  the  human  mind  who  does  not  under- 
stand this  endless  complexity  of  the  material,  and 
who  does  not  see  that  even  the  simplest  mental 
state  practically  presents  a  most  complex  problem  to 
scientific  analysis.  The  physician  who  really  aims  to- 
wards scientifically  exact  influence  on  the  human 
mind  has  reached  the  first  step  of  his  preparation  as 
soon  as  he  understands  that  the  content  of  conscious- 


26  PSYCHOTHERAPY 

ness  is  composed  of  hundreds  of  thousands  of 
elements.  To  treat  the  mind  as  if  there  were  only  a 
few  large  pieces,  one  thing  called  memory  and  one 
thing  called  will  and  one  called  emotion  and  so  on,  is 
as  if  a  surgeon  were  to  perform  an  operation,  know- 
ing that  there  are  arms  and  legs,  but  not  knowing 
the  ramifications  of  the  nerves  and  blood-vessels 
which  his  knife  may  injure.  Yet  the  description  of 
these  complex  facts  is  only  the  beginning  of  psychol- 
ogy. We  saw  that  the  real  aim  is  their  explanation. 


Ill 

MIND  AND  BRAIN 

THE  central  aim  of  the  psychologist  must  be 
to  explain  the  mental  facts.  It  is  not  suffi- 
cient to  describe  the  procession  of  mental  ex- 
periences in  us,  we  must  understand  the  causes  which 
determine  that  now  this  and  now  that  appears  and 
disappears,  and  appears  just  in  this  combination  of 
elements.  The  astronomer  is  not  satisfied  with  de- 
scribing the  stars,  he  wants  to  explain  their  move- 
ments and  to  determine  which  movements  are  to  be 
expected.  The  psychologist,  like  the  naturalist,  aims 
towards  explanation,  and  it  is  this  demand  which 
forces  him  to  look  from  the  psychical  facts  to  the 
physical  ones,  from  the  mind  to  the  brain.  He  is 
under  an  illusion  if  he  fancies  that  he  can  explain 
mental  facts  by  themselves.  The  purposive  mind 
has  its  connection  in  itself,  the  causal  psychological 
mind  demands  for  its  connection  the  body.  To 
understand  this  necessity  is  the  first  step  towards 
understanding  the  relation  of  mind  and  brain. 

The  psychologist's  problem  of  explanation  is  in  one 
way  entirely  different  from  that  of  the  physicist. 
The  physicist  finds  a  world  of  an  unlimited  number 
of  atoms  which  are  ultimately  conceived  as  all  alike, 

27 


28  PSYCHOTHERAPY 

but  each  one  In  a  different  place,  and  all  the  changes 
in  the  universe,  the  movements  of  the  stars,  the  waves 
of  the  ocean,  are  to  be  explained  by  the  causal  con- 
nections of  the  movements  of  these  atoms.  The 
psychologist,  on  the  other  hand,  finds  an  endless  mani- 
foldness  of  elements  which  are  not  in  space,  and 
which  have  no  space  form  whatever.  My  will  is 
neither  triangular  nor  oval;  my  emotion  is  neither 
shorter  than  five  feet  nor  longer;  my  memory  image 
of  a  melody  has  no  thickness  and  no  tallness;  my 
contents  of  consciousness  are  as  such  not  in  space; 
their  elements  cannot  pass  through  any  space  move- 
ments like  the  atoms  of  the  physicist.  Instead  of  it, 
the  psychical  atoms,  the  sensations,  have  different 
qualities,  are  blue  and  green,  and  cold  and  warm,  and 
sweet  and  sour,  and  toothache  and  headache.  The 
changes  which  go  on  in  such  a  system  are  thus  not 
changes  of  position  and  movements,  but  changes  in 
kind  and  strength  and  vividness  and  fusion;  and 
exactly  such  changes  are  the  processes  which  the  psy- 
chologist wants  to  explain.  He  wants  to  make  us 
understand  why  this  idea  grows  up  and  the  other 
fades  away,  why  this  impression  stands  out  with  clear- 
ness as  an  attended  object  while  the  other  lacks  vivid- 
ness and  disappears,  why  this  volition  grows  out  of 
that  emotion,  why  this  feeling  leads  to  this  imagina- 
tive thought. 

The  first  step  towards  such  explanation  is,  of 
course,  in  psychology,  as  in  all  other  sciences,  the 
careful  observation  of  regularities.  It  quickly  leads 
us  to  formulate  some  general  laws.  Psychology  has 


MIND  AND  BRAIN  29 

known,  for  instance,  for  two  thousand  years,  that  if 
we  have  perceived  two  things  together,  and  later  we 
see  the  one  again,  the  new  perception  brings  us  a 
memory  image  of  the  other  thing.  If  we  saw  a 
man's  face  and  heard  at  the  same  time  his  name, 
seeing  his  face  may  later  awaken  in  us  the  memory  of 
his  name,  or  the  hearing  of  his  name  may  later 
awaken  in  us  a  reproduced  memory  image  of  his 
face.  On  such  a  basis,  for  instance,  we  formulate 
some  general  laws  of  association  of  ideas,  and  as  soon 
as  we  have  such  laws~lalcldown,  we  consider  the 
appearance  of  such  a  memory  image  by  association  as 
sufficiently  explained.  We  feel  that  it  gives  us  suffi- 
cient basis  to  predict  that  in  the  future  this  idea  will 
stir  up  in  us  the  other  idea.  Psychology  has  formu- 
lated plenty  of  such  general  statements,  and  they 
serve  well  for  a  first  orientation. 

Yet  can  this  ever  be  considered  as  a  last  word  of 
scientific  explanation  of  psychical  facts?  Can  psy- 
chology really  in  this  way  reach  an  ideal  similar  to 
that  of  scientific  astronomy  or  chemistry?  Would 
the  scientist  of  nature  ever  be  satisfied  with  this  kind 
of  explanation,  which  is  nothing  but  generalization 
of  certain  sequences?  Does  not  the  explanation  of 
the  naturalist  contain  an  entirely  different  element? 
He  does  not  merely  want  to  say  that  this  effect  has 
sometimes  been  observed  and  that  there  is  thus  prob- 
ability that  it  will  come  again,  when  similar  causes 
are  given.  No,  the  physicist  wants  to  understand 
those  connections  of  cause  and  effect  as  necessary 
ones.  He  tries  to  find  sequences  which  cannot  be 


30  PSYCHOTHERAPY 

otherwise  because  they  cannot  be  thought  in  any 
other  way.  Therefore  he  is  not  satisfied  with  com- 
plex regularities,  but  analyzes  them  until  he  can  bring 
them  down  to  simple  physical  connections,  and  these 
physical  connections  finally  to  mechanical  processes, 
which  realize  for  us  logical  necessities.  That  matter 
lasts  and  cannot  disappear  is  such  a  presupposition, 
which  comes  to  us  with  the  necessity  of  logical  think- 
ing. We  simply  cannot  think  it  otherwise.  And 
the  whole  idea  of  natural  science  is  to  conceive  the 
physical  universe  in  such  a  way  that  all  changes  in 
the  outer  world  can  be  understood  as  the  movements 
of  its  parts  in  accordance  with  such  necessary  physical 
axioms.  If  we  knew  all  the  atoms  of  the  present 
status  of  the  universe,  and  we  knew  every  present 
movement  of  every  atom,  we  should  be  able  to  fore- 
see the  position  of  every  atom  in  the  next  moment 
and  in  the  following  moment  and  in  all  following 
moments,  and  all  that  by  the  necessary  continuation 
of  the  substance  and  its  energies.  That  alone  is  the 
background  of  all  special  physical  inquiry,  and  we 
rely  on  the  special  laws  of  physics  and  chemistry,  be- 
cause we  trust  that  this  universe,  as  a  whole,  could 
be  ultimately  understood  as  such  a  system  of  neces- 
sary changes  in  the  positions  of  the  lasting  atoms. 

For  the  psychologist  there  is  no  hope  of  finding 
such  necessity  in  the  mental  processes.  The  point  is 
not  that  psychology  is  to-day  too  far  removed  from 
the  fulfillment  of  such  an  ideal,  the  point  is  rather 
that  such  an  ideal  would  be  meaningless  for  the  psy- 
chologist. His  materials,  the  psychical  contents  of 


MIND  AND  BRAIN  31 

consciousness,  are  by  their  nature  unfit  to  enter  into 
such  necessary  connections ;  they  cannot  do  it  because 
they  cannot  last.  The  physical  object,  we  saw,  is  the 
object  which  is  common  property,  which  we  all  feel 
in  common,  which  must  thus  exist  for  all  time.  The 
things  in  nature  may  burn  down  or  decay,  but  no 
atom  of  them  can  ever  disappear  from  the  universe, 
each  must  enter  into  new  and  ever  new  combinations 
and  last  through  all  changes.  The  psychical  thing, 
on  the  other  hand,  can  exist  only  for  the  one  im- 
mediate experience.  Every  sensation  which  enters 
into  my  ideas  or  volitions  or  emotions  is  a  new  crea- 
tion of  the  instant  which  cannot  last;  each  one  flashes 
up  and  is  lost  with  the  moment's  experience.  My  will 
to-day  may  have  the  same  aim  as  my  will  of  yester- 
day, but  as  psychical  object,  my  will  to-day  is  a  new 
will,  is  a  new  creation  in  every  pulse  beat  of  my  life. 
I  must  will  it  again,  I  cannot  store  it  up.  And  my 
joy  of  to-day  can  never  be  as  psychical  fact  the  same 
joy  which  I  may  have  to-morrow.  Mental  objects 
as  such,  as  psychological  material,  are  not  destined 
to  last.  It  has  no  meaning  whatever  to  think  of 
their  being  kept  over  until  another  time.  It  is  a 
coarse  materialism  to  conceive  the  mental  contents 
like  pebbles  which  may  remain  on  the  road  from  one 
day  to  another.  Our  ideas  and  feelings  are  mental 
appearances  which  have  their  existence  in  the  act  of 
the  one  experience;  each  new  experience  must  be  an 
entirely  new  creation. 

If  I  remember  my  last  year's  perception,  I  do  not 
dig  it  out  from  an  under-mind,  in  which  it  was  stored 


1  1 
|\ 


32  PSYCHOTHERAPY  . 

up  and  buried,  but  I  create  an  entirely  new  memory 
picture,  just  as  I  may  make  to-day  a  speech  which  says 
the  same  thing  which  I  said  last  year,  and  yet  my 
action  of  speaking  is  not  last  year's  speech  movement. 
It  is  a  new  action,  and  the  movement  did  not  lie  over 
somewhere  during  the  interval.  Mental  life  is  pro- 
duced anew  in  every  moment.  When  the  first  ex- 
perience is  gone  and  the  second  comes,  nothing  of  the 
stuff  from  which  the  first  was  made  still  has  existence 
in  the  content  of  consciousness.  By  this  fact  it  be- 
comes entirely  impossible  ever  to  conceive  necessary 
connections  in  the  sense  of  physical  necessity  in  the 
world  of  consciousness.  The  one  idea  may  bring 
to  me  another  idea  by  association,  but  as  long  as  I 
consider  both  strictly  as  mental  facts,  I  can  never 
understand  why  this  association  happens,  I  can  never 
grasp  the  real  mechanism  of  the  connection,  I  can 
never  see  necessity  between  the  disappearance  of  the 
one  and  the  appearance  of  the  other.  It  remains  a 
mystery  which  does  not  justify  any  expectation  that 
the  same  sequence  will  result  again.  Whatever  be- 
longs to  the  psychical  world  can  never  be  linked  by 
a  real  insight  into  necessity.  Causality  there  remains 
an  empty  name  without  promise  of  a  real  explana- 
tion. 

Only  when  we  have  recognized  this  fundamental 
difficulty  in  the  efforts  for  psychological  explanation, 
can  we  understand  the  way  which  modern  psychology 
has  taken  most  successfully.  The  end  of  this  way 
is  simply  this:  every  psychical  fact  is  to  be  thought 
of  as  an  accompaniment  of  a  physical  process  and  the 


MU   \^JL 


MIND  AND  BRAIN  33 

necessary  connections  of  these  physical  processes  de- 
termine, then,  the  connections  of  the  mental  facts. 
Indeed  this  has  become  the  method  of  modern  psy- 
chology. It  has  brought  about  the  intimate  relation 
between  psychology  and  the  physiology  of  the  brain, 
and  has  given  us,  as  foundation,  the  theory  of  psy- 
chophysical  parallelism ;  the  theory  that  there  is  no 
psychical  process  without  a  parallel  brain  process. 
But  the  real  center  of  the  theory  lies  indeed  in  the 
fact  which  we  discussed;  it  lies  in  the  fact  that  we 
cannot  have  any  explanation  of  mental  states  as  such 
at  all,  if  we  do  not  link  them  with  physical  processes. 
Is  it  necessary  to  express  again  the  assurance  that 
such  statements  of  a  parallelism  between  mind  and 
brain  in  no  way  interfere  with  an  idealistic  view  of 
inner  life?  Have  we  not  seen  clearly  enough  that 
these  mental  facts  which  are  conceived  parallel  to 
physiological  brain  processes  do  not  represent  the 
immediate  reality  of  our  inner  life,  that  our  life 
reality  is  purposive  and  as  such  outside  of  all  causal 
explanation,  and  that  we  have  to  take  a  special, 
almost  artificial,  point  of  view  to  consider  inner  life 
at  all  as  objects,  as  contents  of  consciousness,  and 
thus  as  psychological  material?  But  since  we  have 
seen  that  for  certain  purposes  such  a  point  of  view 
is  necessary,  as  soon  as  we  have  taken  it  we  must  be 
consistent.  Our  inner  life  in  its  purposive  reality 
has  therefore  nothing  to  do  with  brain  processes, 
but  if  we  are  on  the  psychological  track  and  consider 
man  as  a  system  of  psychological  phenomena,  then  to 
be  sure,  we  must  see  that  our  only  possible  interest 


34  PSYCHOTHERAPY 

lies  in  the  finding  of  necessary  causal  connections. 
But  these  cannot  be  found  otherwise  than  by  linking 
the  mental  facts  with  the  physical  ones,  the  psycho- 
logical material  with  the  processes  of  the  brain. 

Of  course,  that  mental  experience  stands  in  inti- 
mate relations  to  the  body  is  a  knowledge  which  does 
not  wait  for  such  philosophical  arguments.  That 
mind  and  body  come  in  contact  is  a  conviction  which 
goes  with  every  single  sense  perception.  I  see  and 
hear  because  light  and  sound  stimulate  my  sense 
organs,  and  the  sense  organs  stimulate  my  brain. 
The  explanation  of  perception  through  causes  in  the 
physical  system  seems  the  more  natural  as  it  is  evi- 
dent that  in  such  cases  there  are  no  psychical  causes 
which  might  have  brought  forward  the  perception. 
If  I  suddenly  hear  bells  ringing,  there  was  on  the 
mental  side  nothing  preceding  which  could  be  re- 
sponsible for  my  sound  perception.  And  the  same 
holds  true  if  the  physical  source  lies  in  my  own  body, 
if  perhaps  my  tooth  begins  to  ache,  although  no  ex- 
pectation preceded  it. 

In  the  same  way  it  seems  a  matter  of  course  that 
mind  and  body  are  connected  wherever  an  action  is 
performed.  I  have  the  will  to  grasp  for  the  book 
before  me,  and  obediently  my  arm  performs  the 
movement;  the  muscles  contract  themselves,  the 
whole  physical  apparatus  comes  into  motion  through 
the  preceding  mental  fact.  The  same  holds  true 
where  no  special  will  <*ct  arouses  the  muscles.  If  a 
thought  is  in  my  mind  and  it  discharges  itself  in  ap- 
propriate words,  those  words  are  after  all  as  physical 


MIND  AND  BRAIN  35 

facts  the  movements  of  lips  and  tongue  and  vocal 
cords  and  chest ;  in  short,  a  whole  system  of  physical 
responses  has  set  in  through  a  mental  experience. 
But  the  same  thought  may  be  the  starting-point  for 
many  other  bodily  changes;  it  may  make  me  blush, 
and  that  means  that  large  groups  of  blood-vessels 
become  dilated;  or  I  may  get  pale,  the  blood-vessels 
are  contracted.  Or  I  may  cry,  the  lachrymal  gland 
is  working;  or  it  may  spoil  my  appetite,  the  mem- 
branes of  my  stomach  cease  to  produce;  or  my 
muscles  may  tremble,  or  my  skin  may  perspire;  in 
short,  my  whole  organism  may  resound  with  mental 
excitement  which  some  words  may  set  up. 

But  it  is  not  only  the  impression  of  outer  stimuli 
and  the  expression  of  inner  thoughts  in  which  mind 
and  body  come  together.  Daily  life  teaches  us,  for 
instance,  how  our  mental  states  are  dependent  upon 
most  various  bodily  influences.  If  the  temperature 
of  the  blood  is  raised  in  fever,  the  mental  processes 
may  go  over  into  far-reaching  confusion;  if  hashish 
is  smoked,  the  mind  wanders  to  paradise,  and  a  few 
glasses  of  wine  may  give  a  new  mental  optimism  and 
exuberance;  a  cup  of  tea  may  make  us  sociable,  a 
dose  of  bromide  may  annihilate  the  irritation  of  our 
mind,  and  when  we  inhale  ether,  the  whole  content 
of  consciousness  fades  away.  In  every  one  of  these 
cases,  the  body  received  the  chemical  substance,  the 
blood  absorbed  and  carried  it  to  the  brain,  and  the 
change  in  the  brain  was  accompanied  by  a  change  in 
the  mental  behavior.  Even  ordinary  sleep  at  night 
presents  itself  surely  as  a  bodily  state — the  fatigued 


36  PSYCHOTHERAPY 

brain  cells  demand  their  rest,  and  yet  at  the  same 
time  the  whole  mental  life  becomes  entirely  changed. 
It  is  not  difficult  to  carry  over  such  observations  of 
daily  life  to  the  more  exact  studies  of  the  psycho- 
logical laboratory  and  to  examine  with  the  subtle 
means  of  the  psychological  experiment  the  mental 
variations  which  occur  with  changes  of  physical  con- 
ditions. We  might  feel,  without  instruments,  that 
our  ideas  pass  on  more  easily  after  a  few  cups  of 
strong  coffee,  but  the  laboratory  may  measure  that 
with  its  exact  methods  and  study  in  thousandth  parts 
of  a  second,  the  quickening  or  retarding  in  the  flow  of 
ideas-.  Every  subjective  illusion  is  then  excluded, 
our  electrical  clocks,  which  measure  the  rapidity  of 
mental  action  and  of  thought  association,  will  show 
then  beyond  doubt  how  every  change  in  the  organism 
influences  the  processes  of  the  mind.  Bodily 
fatigue  and  indigestion,  physical  health  and  blood 
circulation,  everything,  influence  our  mental  make- 
up. In  the  same  way  it  is  the  laboratory  ex- 
periment which  shows  by  the  subtlest  means  that 
every  mental  state  produces  bodily  effects  where  we 
ordinarily  ignore  them.  As  soon  as  we  apply  the 
equipment  of  the  psychological  workshop,  it  is  easy 
to  show  that  even  the  slightest  feeling  may  have  its 
influence  on  the  pulse  and  the  respiration,  on  the 
blood  circulation  and  on  the  glands;  or,  that  our 
thoughts  give  impulse  to  our  muscles  and  move  our 
organs  when  we  ourselves  are  entirely  unaware  of  it. 
Again  we  may  turn  in  another  direction.  Pathol- 
ogy shows  us  how  every  physical  disablement  of 


MIND  AND  BRAIN  37 

the  brain  is  accompanied  by  mental  processes.  If 
the  blood  supply  to  the  brain  is  cut  off,  we  faint;  a 
blow  on  the  head  may  wipe  out  the  memory  of  the 
preceding  hours,  and  a  hemorrhage  in  the  brain, 
the  bursting  of  a  blood  vessel  which  destroys  groups 
of  brain  cells,  produces  serious  defects  in  the  mental 
content.  A  tumor  in  the  brain  may  completely 
change  the  personality;  the  bodily  disease  of  certain 
convolutions  in  the  brain  brings  with  it  the  loss  of 
the  power  of  speech;  paralysis  of  the  brain  dissolves 
the  whole  mental  personality.  Physical  inhibition  in 
the  growth  of  the  brain  involves,  on  the  mental  side, 
feeble-mindedness  and  idiocy.  Of  course,  all  this  is 
not  sufficient  to  bring  out  a  definite  parallelism  be- 
tween special  mental  functions  and  special  physical 
processes,  as  the  phenomena  are  extremely  complex. 
If  a  patient  who  has  suffered  from  a  mental  disturb- 
ance dies,  and  his  brain  is  examined,  there  is  no 
simple  correlation  before  us.  It  may  be  difficult  to 
diagnose  exactly  the  mental  symptoms.  If  we  have 
heard  that  the  man  was  unable  to  read,  we  do  not 
know  from  that  what  really  happened  in  his  brain. 
He  may  not  have  read  because  he  did  not  see  the 
words,  or  because  the  letters  were  confusing,  or  be- 
cause he  had  lost  memory  for  the  meaning,  or  be- 
cause he  had  lost  the  impulse  to  speak  the  words,  or 
because  he  felt  unable  to  turn  his  attention,  or  be- 
cause the  impulse  to  read  aloud  was  not  carried  out 
by  his  organism,  or  because  an  inner  voice  told  him 
that  it  is  a  sin  to  read,  or  for  many  similar  reasons; 
and  yet  each  one  represents  psychologically  an  en- 


38  PSYCHOTHERAPY, 

tirely  different  situation.  On  the  other  hand,  on  the 
physical  side,  the  destruction  is  probably  not  confined 
to  one  particular  spot.  Complications  have  crept 
over  to  other  places  or  the  disturbance  in  one  part 
works  as  inhibitory  influence  on  other  brain  parts,  or 
a  tumor  may  press  on  a  far-removed  part,  or  the  dis- 
turbance may  be  one  which  cannot  be  examined  with 
our  present  microscopic  means.  In  short,  we  have 
always  a  complex  mental  situation  and  a  complex 
physical  one,  and  to  find  definite  correlations  may 
be  possible  only  by  the  comparison  of  very  many 
cases. 

Other  methods,  however,  may  supplement  the 
pathological  one.  The  comparative  anatomist 
shows  us  that  the  development  of  the  central  nervous 
system  in  the  kingdom  of  animals  goes  parallel  to  the 
development  of  the  mental  functions,  and  that  it  is 
not  only  a  question  of  progress  along  all  lines.  Any 
special  function  of  the  mind  may  have  in  certain  ani- 
mal groups  an  especially  high  development,  and  we 
see  certain  parts  correspondingly  developed.  The 
dog  has  certainly  a  keener  sense  of  smell  than  the 
man — the  part  of  the  brain  which  is  in  direct  con- 
nection with  the  olfactory  nerve  is  correspondingly 
much  bulkier  in  the  dog's  brain  than  in  the  human 
organism.  Here  too,  of  course,  research  may  be 
carried  to  the  subtlest  details  and  the  microscope  has 
to  tell  the  full  story.  Not  the  differences  in  the  big 
structure,  but  the  microscopical  differences  in  the 
brain  cells  of  special  parts  are  to  be  held  responsible. 
But  comparison  may  not  be  confined  to  the  various 


MIND  AND  BRAIN  39 

species  of  animals;  it  may  refer  not  less  to  the  various 
stages  of  man.  The  genetic  psychologist  knows  how 
the  child's  mind  develops  in  a  regular  rhythm,  one 
mental  function  after  another,  how  the  first  days  and 
first  weeks  and  first  months  in  the  infant's  life  have 
their  characteristic  mental  possibilities,  and  no  men- 
tal function  can  be  anticipated  there.  The  new-born 
child  can  taste  milk,  but  cannot  hear  music.  The 
anatomist  shows  us  that  correspondingly  only  certain 
nervous  tracts  have  the  anatomical  equipment  by 
which  they  become  ready  for  functioning.  Most  of 
the  tracts  at  first  lack  the  so-called  medullar  sheath, 
and  from  month  to  month  new  paths  are  provided 
with  this  physical  equipment. 

Finally  we  have  the  experiment  of  the  physiologist. 
His  vivisectional  experiments,  for  instance,  demon- 
strate that  the  electrical  stimulation  of  a  definite  spot 
on  the  surface  of  a  dog's  brain  produces  movements 
which  we  should  ordinarily  take  as  expressions  of 
mental  states,  movements  of  the  front  legs  or  of  the 
tail,  movements  of  barking  or  whining.  On  the 
other  hand,  the  dog  becomes  unable  to  fulfill  the 
mental  impulses  if  certain  definite  parts  of  his  brain 
are  destroyed.  The  physiologist  may  show  from  the 
monkey  down  to  the  pigeon,  to  the  frog,  to  the  ant, 
to  the  worm,  how  the  behavior  of  animals  is  changed 
as  soon  as  certain  groups  of  nervous  elements  are 
extirpated.  It  is  the  mental  emotional  character  of 
the  pigeon  which  is  changed  when  the  physiologist 
cuts  off  parts  of  his  brain.  In  short,  stimulation  and 
destruction  demonstrate,  by  experiments  which  sup- 


40  PSYCHOTHERAPY 

plement  each  other,  that  mental  functions  correspond 
to  brain  functions. 

There  is  thus  no  lack  of  demonstration  from  all 
quarters  that  mental  facts  and  brain  processes  belong 
together;  and  yet,  however  much  we  may  cumulate 
such  popular  and  scientific  observations,  they  would 
never  by  themselves  admit  of  the  sweeping  gen- 
eralization that  there  cannot  be  any  mental  state 
which  is  not  accompanied  by  a  process  in  the  central 
nervous  system.  Someone  might  say,  to  be  sure,  the 
perceptions  and  memory  images,  the  volitions  and 
instincts  and  impulses,  have  their  physiological  basis, 
but'  there  remain  after  all  acts  of  attention,  or 
decisions,  or  subtle  feelings,  or  flights  of  imagination, 
which  are  independent  of  any  brain  action.  Here, 
indeed,  observation  cannot  settle  such  a  general  prin- 
ciple. Its  real  hold  lies  in  the  fact  with  which  we 
started:  there  is  no  causal  connection  in  the  mental 
states  as  such.  If  we  want  to  understand  mental 
facts  as  such  in  a  chain  of  causal  events,  we  have  first 
to  conceive  them  as  parallel  to  physical  events.  The 
principle  of  psychophysical  parallelism,  that  is,  the 
principle  that  every  psychical  process  accompanies  a 
physiological  change  is  thus  not  a  mere  result  of  ob- 
servation. It  is  simply  a  postulate.  Every  science 
begins  with  postulates  and  only  that  which  fulfills  such 
postulates  has  the  dignity  of  truth  in  the  midst  of 
that  scientific  realm.  The  astronomer  cannot  find  by 
observation  that  there  is  no  star  the  movements  of 
which  are  not  the  effects  of  foregoing  causes.  He 
knows  it  beforehand,  he  demands  it,  he  does  not 


MIND  AND  BRAIN  41 

recognize  any  movement  as  understood  until  he  has 
found  the  causes,  he  presupposes  that  such  causes 
exist,  that  no  star  moves  simply  by  a  magic  power, 
and  that  nowhere  in  the  astronomical  universe  is  the 
chain  of  causality  broken.  He  postulates  it,  and 
where  he  does  not  discover  the  causes,  he  is  sure  that 
he  has  not  solved  the  real  problem. 

In  the  same  way  the  psychologist  who  aims  to-  /  o 
wards  explanation  of  mental  facts  must  postulate  that 
there  cannot  be  any  mental  state  which  is  not  an 
accompaniment  of  a  physical  brain  process,  and  is  as 
such  connected  through  physical  means  with  the  pre- 
ceding and  the  following  events  in  the  psychophysical 
system.  Only  when  such  a  general  framework  of 
theory  is  built  up  by  a  logical  postulate,  is  the  way 
open  to  make  use  of  all  those  observations  of  the 
laboratory  and  of  the  clinic,  of  the  zoologist  and  of 
the  anatomist.  It  is  the  theory  which  has  to  give  the 
right  setting  to  those  scattered  observations.  How- 
ever far  we  may  be  from  being  able  to  point  to  the 
special  brain  process  which  lies  at  the  bottom  of  the 
higher  mental  state,  we  know  beforehand  that  there 
is  no  shadow  of  an  idea,  no  fringe  of  a  feeling,  no 
suggestion  of  a  desire  which  does  not  correspond  to 
definite  processes  in  the  brain.  The  details  may  and 
must  be  material  for  diverging  theories,  but  the 
conflict  of  such  hypothetical  opinions  has  nothing  to 
do  with  the  certainty  of  the  underlying  conviction 
that  if  we  knew  the  whole  truth,  we  should  recognize 
every  single  mental  happening  as  parallel  to  physical 
processes  in  the  nervous  system.  To  explain  mental 


42  PSYCHOTHERAPY 

facts  means  to  think  them  as  parallel  to  the  brain 
processes  which  have  their  own  causal  connections  in 
the  physical  world. 

We  started,  for  instance,  from  the  old  observation 
that  two  impressions  which  come  to  our  mind  at  the 
same  time  have  a  tendency  to  reawaken  one  another; 
and  we  saw  that  psychology  was  well  able  to  formu- 
late these  facts  in  general  statements  of  the  associa- 
tion of  ideas.  But  we  realized  that  that  in  itself  is 
not  really  explanation.  If  the  odor  which  we  smell 
awakes  in  us  the  name  of  a  chemical  substance,  and  if 
we  now  bring  this  under  the  general  heading  of  as- 
sociation of  ideas,  an  explanation  is  not  really  given 
by  it.  That  smell  sensation  itself  is  not  really  under- 
stood as  a  cause  of  those  sound  sensations  of  the 
word.  We  have  no  insight  into  the  connection  of 
those  two  happenings.  But  the  situation  is  entirely 
changed,  if  we  consider  the  smell  effect  from  the  point 
of  view  of  the  parallelistic  theory.  Now  the  as- 
sociation of  facts  would  indicate  that  we  got  the  first 
two  impressions  together,  because  two  brain  processes 
were  going  on  at  the  same  time.  My  nose  brought 
me  the  smell  stimulus,  my  ear  gave  me  the  sound 
stimulus,  each  going  on  in  a  particular  center,  or,  to 
express  it  in  a  simplified  schematic  way,  each  reaching 
particular  brain  cells,  and  the  excitement  of  these 
brain  cells  being  accompanied  by  the  particular 
sensations.  The  physiologist  has  many  possibil- 
ities of  conceiving  the  further  stages  of  the 
process,  in  order  to  satisfy  the  demand  of  ex- 
planation. He  may  say  the  excitement  of  each 


MIND  AND  BRAIN  43 

of  these  two  brain  cells,  the  one  in  the  olfactory 
center,  the  other  in  the  auditory  center,  irradiates 
in  all  directions  through  the  fine  branches  of  the 
brain  fibers.  Each  cell  has  relations  to  every  other 
cell  in  the  brain ;  thus  there  is  also  one  connecting  path 
between  those  two  cells  which  were  stimulated  at 
once.  Now  if  the  two  ends  of  an  anatomical  path 
are  excited  at  the  same  time,  the  path  itself  becomes 
changed.  The  connecting  way  becomes  a  path  of 
least  resistance,  and  that  means  that  if,  in  future,  one 
of  the  two  brain  cells  becomes  excited  again,  the 
overflow  of  the  nervous  excitement  will  not  now  go 
on  easily  in  all  directions,  but  only  just  along  that  one 
channel  which  leads  to  that  other  brain  cell.  A 
theory  like  this  explains  in  real  explanatory  terms,  in 
ways  which  physics  and  chemistry  can  demonstrate  as 
necessary,  that  any  excitement  of  the  odor  cell  runs 
over  into  the  sound  cell  and  vice  versa.  In  short,  the 
psychological  association  of  ideas,  which  we  should 
simply  have  to  accept  as  inexplainable  fact,  is  thus 
transformed  into  a  connection  which  we  understand 
as  necessary;  and  the  fact  is  really  explained. 

This  simple  scheme  of  the  physiology  of  associa- 
tion for  a  hundred  years  has  given  a  most  decided 
impulse  to  the  progress  of  psychology.  As  the  as- 
sociation process  can  so  easily  be  expressed  in  physio- 
logical terms,  the  aim  was  prevalent  to  understand 
the  interplay  of  mental  life  more  and  more  as  the 
result  of  association.  The  underlying  thought  of 
this  whole  association  psychology  was  thus  a  con- 
viction that  whenever  two  mental  experiences  occur 


44  PSYCHOTHERAPY 

together,  either  of  them  keeps  the  tendency  to  re- 
awaken the  other  at  a  later  time.  Through  the  end- 
less combination  which  life's  impressions  awaken  in 
the  mind  from  the  first  hour  after  birth,  the  whole 
stream  of  memory  images  and  thoughts  and  aims 
and  imaginations  is  thus  to  be  explained. 

The  whole  theory  of  physiological  associationism 
works  evidently  with  two  factors.  First,  there  are 
millions  of  brain  cells  of  which  each  one  may  have  its 
particular  quality  of  sensation,  and  second,  each  brain 
cell  may  work  with  any  degree  of  energy,  to  which 
the  intensity  of  the  sensation  would  correspond.  If 
I  distinguish  ten  thousand  different  pitches  of  tone, 
they  would  be  located  in  ten  thousand  different  eel? 
groups,  each  one  connected  through  a  special  fiber 
with  a  special  string  in  the  ear.  And  each  of  these 
tones  may  be  loud  or  faint,  corresponding  to  the 
amount  of  excitement  in  the  particular  cell  group. 
Every  other  variation  must  then  result  from  the  mil- 
lionfold  connections  between  these  brain  cells.  In- 
deed, the  brain  furnishes  all  possibilities  for  such  a 
theory.  We  know  how  every  brain  cell  resolves 
itself  into  tree-like  branch  systems  which  can  take  up 
excitements  from  all  sides,  and  how  it  can  carry  its 
own  excitement  through  long  connecting  fibers  to  dis- 
tant places,  and  how  the  endings  of  these  fibers  clasp 
into  the  branches  of  the  next  cell,  allowing  the  propa- 
gation of  excitement  from  cell  to  cell.  We  know  fur- 
ther how  large  spheres  of  the  brain  are  confined  to 
cells  of  particular  function,  that  for  instance  cells 
which  serve  visual  sensations  are  in  the  rear  part  of 


MIND  AND  BRAIN  45 

the  brain  hemispheres,  and  so  on.  Finally  we  know 
how  millions  of  connecting  fibers  represent  paths  in 
all  directions,  allowing  very  well  a  cooperation  by 
association  between  the  most  distant  parts  of  the 
brain.  The  theories  found  their  richest  development, 
when  it  was  recognized  that  large  spheres  of  our 
brain  centers  evidently  do  not  serve  at  all  merely 
sensory  states,  but  that  their  cells  have  as  their  func- 
tion only  the  intermediating  between  different  sensory 
centers.  Such  so-called  association  centers  are  thus 
like  complex  switchboards  between  the  various  men- 
tal centers.  Their  own  activity  is  not  accompanied 
by  any  mental  content,  but  has  only  the  function  of 
regulating  transmission  of  the  excitement  from  the 
one  to  the  other.  Above  all  their  operation  would 
make  it  possible  that  through  associative  processes, 
the  wonderful  complexity  of  our  trains  of  thought 
may  be  reached. 

Yet  even  the  highest  development  of  the  associa- 
tion theories  did  not  seem  to  do  justice  to  the  whole 
richness  of  the  inner  life.  We  may  well  understand 
through  those  association  processes  that  a  rich  supply 
of  memory  pictures  is  at  our  disposal,  that  ideas 
stream  plentifully  to  our  minds  and  enter  into  new 
and  ever  new  combinations.  But  that  alone  is  not 
an  account  of  our  inner  experience.  If  there  is  any- 
thing essential  for  inner  life,  it  is  the  attention  which 
gives  emphasis  to  certain  states  and  neglects  others. 
And  that  means  that  certain  mental  contents  are 
growing  not  only  in  strength  but  in  vividness  and 
clearness,  and  that  others  are  losing  their  vividness, 


46  PSYCHOTHERAPY 

are  inhibited  and  suppressed.  Here  were  always  the 
real  difficulties  of  the  association  theories;  they 
seemed  so  entirely  unable  to  explain  from  their  own 
means  why  certain  states  become  foremost  in  our 
minds  and  others  fade  away,  why  some  have  the 
power  to  grow  and  others  are  neglected.  These 
facts  of  attention  and  vividness,  inhibition  and 
fading,  worked  almost  as  a  temptation  to  give  up  the 
physiological  explanation  altogether  and  to  rely  on 
some  mystical  power,  some  mental  influence  which 
could  pull  and  push  the  ideas  without  any  inter- 
ference and  help  from  the  side  of  the  brain.  Yet 
since  we  have  seen  that  the  truth  of  psychophysical 
parallelism  has  the  meaning  of  a  postulate  which  we 
cannot  escape  unless  we  want  to  give  up  explanation 
altogether,  it  is  evident  that  such  falling  back  into  un- 
physiological  agencies  would  be  just  as  inconsistent  as 
if  the  naturalist  should  posit  miracles  in  the  midst  of 
chemistry  or  astronomy.  If  the  facts  which  cluster 
about  attention  cannot  be  understood  by  the  simple 
scheme  of  associationism,  the  demand  must  be  for 
a  better  physiological  theory. 

The  development  of  physiological  psychology  in 
recent  years  has  indeed  shown  the  way  to  such  a 
wider  theory,  which  furnishes  the  physiological  ac- 
companiment also  for  those  experiences  of  attention 
and  vividness  which  form  the  weakness  of  associa- 
tionism. This  new  development  has  come  up  with 
the  growing  insight  that  the  brain's  mental  functions 
are  related  not  only  to  the  sensory  impressions,  but  at 
the  same  time  to  the  motor  expressions.  The  older 


MIND  AND  BRAIN  47 

view,  still  prevalent  to-day  in  popular  writings,  made 
the  brain  the  reservoir  of  physical  stimuli,  which 
come  from  the  sense  organs  to  the  cortex  of  the  brain 
hemispheres.  There  the  perceptions  arose  and 
through  associative  interplay  the  memory  pictures 
and  the  ideas  of  action  and  the  feelings  arose,  and  the 
whole  inner  life  was  thus  bound  up  with  the  processes 
in  these  sensorial  spheres.  When  the  mind  had  done 
its  work,  finally  an  impulse  was  sent  to  some  motor 
apparatus  in  the  brain  which  then  sent  off  the  im- 
pulse to  some  acting  muscles.  That  whole  motor 
part  was  thus  a  kind  of  appendix  to  the  brain  process. 
The  psychical  life  had  nothing  to  do  with  it  but  to 
give  the  command  for  its  action.  The  process  in  the 
motor  part  thus  began  when  the  mental  proceeding 
was  completed.  But  it  became  clear  that  this  view 
was  only  the  outgrowth  of  the  strong  interest  which 
physiology  took  in  the  sense  processes.  If  a  neutral 
fair  account  of  the  brain  actions  is  attempted,  there 
can  hardly  be  doubt  that  this  whole  sensorial  view 
of  the  brain  is  only  half  of  the  story  and  that  the 
motor  half  has  exactly  the  same  right  to  consider- 
ation. The  cortex  of  the  brain,  the  functions  of 
which  are  accompanied  by  mental  processes,  is  always 
and  everywhere  not  only  the  recipient  of  sensory 
stimuli  but  at  the  same  time  the  starting  point  of 
motor  impulses.  That  which  is  centripetal,  leading 
to  the  cortex,  is  therefore  not  more  important  for  the 
central  process  than  that  which  is  centrifugal,  leading 
from  the  cortex.  The  cortex  is  the  apparatus  of 
transmission  between  the  incoming  and  the  outgoing 


sJ 
v  / 


48  PSYCHOTHERAPY 

currents,  between  the  excitements  which  run  to  the 
brain  and  the  discharges  which  go  from  the  brain, 
and  the  mental  accompaniments  are  thus  accompani- 
ments of  these  transmission  processes.  If  the  chan- 
nels of  discharge  are  closed  and  the  transmission  is 
thus  impossible,  a  blockade  must  result  at  the  central 
station  and  the  accompanying  mental  processes  must 
be  entirely  different  from  those  which  happen  there 
when  the  channels  of  discharge  are  wide  open.  Here 
too  all  the  special  theories  are  still  in  the  midst  of 
tumultuous  discord.  Yet  this  new  emphasis  on  the 
motor  side  of  the  psychical  process  seems  to  influence 
modern  psychology  more  and  more. 

Nobody  can  deny  that  first  of  all  this  is  the  neces- 
sary outcome  of  a  biological  view  of  the  brain. 
What  else  can  be  the  brain's  function  in  the  midst 
of  nature  than  the  transforming  of  impressions  into 
expressions,  stimuli  into  actions?  It  is  the  great 

y  apparatus  by  which  the  organism  steadily  adjusts 
itself  to  the  surroundings.  There  would  be  no  use 
whatever  biologically  in  a  brain  which  had  connec- 
tions with  the  sense  organs,  but  which  had  no  con- 
nections with  the  muscular  system,  and  on  the  other 
hand,  a  brain  which  had  motor  nerves  and  muscular 
adjustment  would  be  entirely  useless  if  it  had  not 
sensory  nerves  and  sense  organs  connected  with  it. 
In  the  one  case  the  world  would  be  experienced,  but 
no  response  would  be  possible ;  in  the  other  case,  the 
means  for  response  would  be  given,  but  no  adjust- 
ment could  set  in  because  no  experience  of  the  sur- 
roundings would  be  possible.  Adjustment  every 


MIND  AND  BRAIN  49 

moment  demands  the  relation  of  the  brain  in  both 
directions.  Through  the  sensory  nerves  the  brain 
receives;  through  the  motor  nerves  the  brain  directs, 
and  this  whole  arc  from  the  sense  organs  through  the 
sensory  nerves,  through  the  brain,  through  the  motor 
nerves  and  finally  to  the  muscles,  is  one  unified  ap- 
paratus of  which  no  part  can  be  thought  away.  The 
brain  in  itself  would  be  just  as  useless  for  the  organ- 
ism as  the  heart  would  be  without  the  arteries  and 
veins. 

We  must  keep  this  intimate  and  necessary  relation 
between  the  sensory  and  motor  parts  constantly  in 
view,  and  must  understand  that  there  cannot  be  any 
sensory  process  which  does  not  go  over  into  motor 
response.  Then  only  the  ways  are  ,open  to  develop 
physiological  views  which  give  a  physical  basis  to  the 
processes  of  attention  and  vividness  and  inhibition, 
just  as  well  as  to  the  processes  of  memory  and  as- 
sociation. Such  motor  theories  take  many  forms. 
Perhaps  we  shall  most  quickly  bring  the  most  es- 
sential factors  together,  if  we  say  that  full  vividness 
belongs  only  to  those  sensations  for  which  the  chan- 
nels of  motor  discharge  are  open,  while  those  are  in- 
hibited for  which  the  channels  of  discharge  are 
closed;  and  any  channel  of  discharge  is  closed,  if 
action  is  proceeding  in  the  opposite  channel.  If  I 
open  my  hand,  the  motor  paths  which  lead  to  closing 
my  fist  are  blocked;  and  if  I  close  my  fist,  the  channels 
which  lead  to  the  opening  of  the  hand  are  closed. 
Now  if  only  those  ideas  are  vivid  which  find  the 
channels  open,  it  is  clear  that  all  the  ideas  which 


5o  PSYCHOTHERAPY 

would  lead  to  the  opposite  action  have  no  chance  for 
development;  they  remain  inhibited,  and  just  this  re- 
lation between  the  vividness  of  certain  ideas  and  in- 
hibition for  those  ideas  which  lead  to  the  opposite 
action  is  the  characteristic  of  the  process  of  attention. 

From  such  a  point  of  view,  the  total  mental  life 
can  be  brought  into  the  psychophysical  scheme.  We 
now  have  not  two  variable  factors,  but  three,  namely, 
the  qualities  of  the  elements,  the  intensities  of  the  ele- 
s  ments,  and,  as  a  third?  the  vividness  of  the  elements. 
The  quality  corresponds,  as  we  saw  in  the  association 
theory,  to  the  local  position  and  connection  of  the 
brain  cells;  the  intensity  corresponds  to  the  energy  of 
the  excitement;  and  the  vividness,  we  may  add  now, 
corresponds  to  the  relation  to  motor  channels.  The 
whole  mental  life  thus  becomes  the  accompaniment 
of  a  steady  process  of  transmitting  impressions  and 
memories  into  reactions.  That  every  experience  in- 
volves millions  of  such  elements  we  saw  when  we 
spoke  of  the  description  of  mental  life.  The  effort 
to  explain  mental  life  shows  us  now  that  this  million- 
fold  manifoldness  belongs  to  a  system  of  reactions  of 
which  all  parts  are  in  steady  correlation:  a  moving 
equilibrium  of  unlimited  complexity.  Surely  no  one 
can  reduce  this  wonderful  manifoldness  to  those 
clumsy  concepts  with  which  popular  psychology  is 
reporting  the  story  of  the  mind  and  its  relations  to 
the  brain. 

It  may  seem  that  such  a  psychological  view  of  in- 
ner life  annihilates  that  which  we  feel  as  the  most 
essential  characteristic  of  our  inner  experience,  its 


MIND  AND  BRAIN  51 

unity  and  its  freedom.  In  one  sense  that  is  certainly 
true.  In  the  real  life  which  we  live  and  fight 
through,  where  our  duties  and  our  happiness  lie,  we 
know  a  unity  and  freedom  of  our  personality  which 
psychology  must  destroy.  Of  course  that  does  not 
mean  that  psychology  denies  the  truth  of  that  free- 
dom and  unity.  Moreover  it  would  condemn  itself 
if  it  were  to  deny  that  which  gives  meaning  to  the 
endeavors  of  our  life  and  thus  also  to  every  search 
for  truth.  Psychology  claims  only  that  we  must  ab- 
stract from  it,  when  we  take  the  psychological  stand-  • 
point  towards  life.  Freedom  of  our  real  life  means \\ 
that  we  must  know  ourselves  in  the  midst  of  our  life  \  \ 
work  as  guided  by  aims  and  obligations,  and  that  in  \\ 
this  purposive  existence  of  ourselves  we  do  not  feel  \ 
ourselves  as  determined  by  causes.  I  will  the  fulfill-  ^ 
ment  of  my  ideals  only  because  I  will  them.  That 
this  will  itself  may  be  the  effect  of  foregoing  causes 
is  an  aspect  which  does  not  belong  to  my  naive  ex- 
perience. Our  freedom  means  that  in  our  real  life 
our  will  is  not  related  to  causes,  that  the  point  of 
view  of  causality  is  thus  meaningless  for  the  value  of 
our  achievements.  And  the  other  man's  will  too 
comes  in  question  for  us  as  something  to  be  inter- 
preted and  to  be  appreciated,  but  not  to  be  explained 
by  connection  with  causes.  As  long  as  we  move  in  this 
sphere  of  purposive  interest,  we  are  free  and  deal 
with  free  selves;  but  if  in  the  midst  of  these  free  aims, 
the  will  arises  to  consider  the  actions  of  others  and  of 
ourselves  from  the  standpoint  of  causality,  then  we 
have  ourselves  decided  to  enter  a  new  sphere  in  which 


52  PSYCHOTHERAPY 

it  would  be  meaningless  to  seek  for  any  will  which 
is  not  determined  by  causes.  As  soon  as  we  have 
chosen  the  psychological  standpoint  and  are  in  the 
midst  of  the  work  of  causal  reconstruction,  any  will 
which  is  not  understood  as  determined  by  causes  is 
simply  an  unsolved  problem.  In  the  midst  of  a 
causal  construction,  absence  of  causes  would  never 
mean  real  freedom. 

In  that  purposive  world  of  immediate  life  experi- 
ence, we  also  are  unities  inasmuch  as  we  ourselves 
know  us  as  the  same  in  every  new  will  of  ours.  We 
remain  identical  with  ourselves  because  every  purpose 
is  posited  in  the  midst  of,  and  bound  up  with,  the 
general  purpose  of  ourselves.  And  in  this  internal 
unity  of  meaning,  nothing  breaks  ourselves  into 
pieces,  and  the  whole  manifold  of  experience  is  thus 
expressed  by  a  personality  which  knows  itself  in  its 
purposive  unity.  But  this  unity  again  is  denied  by 
our  own  intention  as  soon  as  we  decide  to  take  the 
causal  view  of  inner  life.  The  purposive  unity  must 
now  transform  itself  into  an  endless  complexity,  and 
our  own  self  becomes  a  composite  of  hundreds  of 
thousands  of  elements. 

On  the  other  hand,  all  this  does  not  mean  that  psy- 
chology cannot  have  its  own  consistent  conception  of 
the  mind's  unity  and  freedom.     Our  psychological^ 
mind  is  a  unity  because  its  manifold  is  a  system  in  ; 
which  all  parts  hang  together.     A  change  in  any  one/ 
part  involves  changes  in  the  whole  system.     The 
interrelation,  to  be  sure,  is  not  a  strictly  psychical  one, 
for  we  have  seen  that  the  causal  connection  as  such 


MIND  AND  BRAIN  53 

appears  at  the  physical  side.  But,  inasmuch  as 
there  is  no  psychical  process  which  does  not  belong 
to  a  physiological  one,  the  interconnection  of  the 
mental  facts  is  complete  and  involves  the  totality  of 
neural  processes  of  which  after  all  a  small  part  only 
has  its  psychological  record.  We  might  compare 
those  hundreds  of  millions  of  neurons  in  each  brain 
with  the  hundreds  of  millions  of  individuals  who 
make  up  the  population  of  the  nations,  and  the  psy- 
chical accompaniment  we  might  compare  with  the 
written  historical  record  of  mankind.  The  written 
records  themselves  have  no  direct  interconnection, 
they  are  only  accompaniments  of  what  happens  in 
these  millions  of  men.  And  again  only  the  higher 
layer  of  the  neurons  in  the  population  sees  its  doings 
recorded  in  the  annals  of  history;  and  yet  whatever 
those  leaders  of  action  and  thought  and  emotion  may 
achieve  is  dependent  upon  and  working  on  the  actions 
of  those  millions  of  subcortical  population  neurons. 
The  historical  record  has  its  unity  through  the  inter- 
relation of  all  parts  of  historical  mankind. 

But  after  all  the  psychologist  has  no  less  a  right  to 
speak  of  freedom.  Of  course  his  freedom  cannot 
mean  exemption  from  causality.  Whatever  hap- 
pens in  the  psychological  system  must  be  perfectly 
determined  by  the  foregoing  causes.  But  the  psy- 
chologist has  good  reason  to  discriminate  between 
those  actions  which  result  from  the  normal  psycho- 
physical  factors  and  such  actions  as  result  from 
broken  machinery.  If  the  brain  is  poisoned  by  al- 
cohol or  in  fever,  if  an  infectious  disease  has  de- 


54  PSYCHOTHERAPY 

stroyed  the  brain  cells,  action  is  no  longer  the  out- 
come of  the  normal  cooperation  of  the  organs,  and 
even  those  clusters  of  neural  activities  which  are  ac- 
companied by  the  consciousness  of  the  own  person- 
ality lose  their  control  of  the  motor  outcome.  The 
man  in  delirium  or  paralysis  acts  without  causal  con- 
nection with  his  past;  the  action  is,  therefore,  not 
the  product  of  his  whole  personality,  and  the  psychol- 
ogist is  justified  in  calling  the  man  unfree.  But, 
whenever  the  motor  response  results  from  the  un- 
disturbed cooperation  of  the  normal  brain  parts,  then 
the  inherited  equipment  and  the  whole  experience  and 
the  whole  training,  the  acquired  habits  and  the  ac- 
quired inhibitions  will  count  in  bringing  about  the 
i  reaction.  This  is  the  psychological  freedom  of  man. 
The  unity  of  an  interconnected  composite  and  the 
freedom  of  causal  determination  through  normal  co- 
operation of  all  its  parts  characterize  the  only  per- 
sonality which  the  psychologist  has  to  recognize. 


IV 

PSYCHOLOGY  AND  MEDICINE 

WE  are  now  ready  to  take  the  first  step 
towards  an  examination  of  the  problem 
of  curing  suffering  mankind.  So  far 
we  have  spoken  only  of  the  meaning  of  psychol- 
ogy, of  its  principles  and  of  its  fundamental 
theories  as  to  mind  and  brain.  We  have  moved 
in  an  entirely  theoretical  sphere.  Now  we  ap- 
proach a  field  in  which  everything  is  controlled  by 
a  practical  aim,  the  treatment  of  the  sick.  Yet  our 
discussion  of  psychology  should  have  brought  us 
much  nearer  to  the  point  where  we  can  enter  this 
realm  of  medicine.  Everything  depends  on  the  right 
point  of  entrance.  That  an  influence  on  the  inner 
life  of  man  may  be  beneficial  for  his  health  is  a  com- 
monplace truth  to-day  for  everybody.  Every  serious 
discussion  of  the  question  has  to  consider  which  in- 
fluences are  appropriate,  and  in  which  cases  of  illness 
the  influence  on  inner  life  is  advisable.  The  popular 
treatises  usually  start  this  chapter  by  speaking  of  the 
"mental  and  moral"  factors;  and  this  coupling  of 
mental  influences  and  moral  influences  characterizes 
large  parts  of  the  discussions  of  the  Christian  Scien- 
tists and  the  Christian  half-scientists.  Yet  we  must 

55 


56  PSYCHOTHERAPY 

insist  that  the  right  entrance  to  psychotherapy  is 
missed  if  the  difference  between  morality  and  men- 
tality is  not  clearly  recognized  from  the  beginning. 
The  confusion  of  the  two  harms  every  statement. 
To  avoid  such  a  fundamental  mistake,  we  had  to 
take  the  long  way  around  and  to  examine  carefully 
what  psychology  really  means  and  what  it  does  not 
mean. 

We  know  now  that  inner  life  can  be  looked  on 
from  two  entirely  different  standpoints:  a  purposive 
one  and  a  causal  one,  and  we  have  seen  that  these 
two  ways  of  looking  on  inner  life  bring  about  en- 
tirely different  aspects  of  man's  inner  experience, 
serve  different  aims,  and  stand  in  different  relations 
to  the  immediate  needs  of  our  real  life.  We  know 
that  the  one,  the  causal  aspect,  belongs  to  psychology, 
while  the  non-psychological,  the  purposive  aspect,  be- 
longs to  our  immediate  mutual  understanding  in  the 
walks  of  life.  If  the  physician  is  to  make  use  of 
inner  experience  in  the  interests  of  overcoming  sick- 
ness, he  must  first  decide  whether  to  take  the  causal 
or  the  purposive  point  of  view  in  dealing  with  the 
patient's  mind.  This  problem  is  too  carelessly 
ignored  and  through  that  neglect  arises  much  of  the 
popular  confusion.  Of  course  just  this  carelessness 
becomes  in  some  ways  the  ground  for  apparent 
strength  for  many  a  superstition  and  prejudice.  If 
the  doors  of  the  causal  mind  and  of  the  purposive 
mind  are  both  open,  and  the  spectator  does  not  notice 
that  there  are  two,  any  trick  on  thought  and  reason 
can  easily  be  played.  Whatever  cannot  pass  through 


PSYCHOLOGY  AND  MEDICINE       57 

the  causal  door  slips  in  through  the  other,  and  what- 
ever does  not  go  in  through  the  door  of  purpose 
marches  through  the  entrance  of  causality.  With 
such  methods  anything  can  be  proved,  and  the  most 
unscrupulous  doctrines  can  be  nicely  demonstrated. 
If  we  are  to  avoid  such  logical  smuggling,  we  must 
see  clearly  which  attitude  towards  mental  life  belongs 
properly  to  the  domain  of  psychotherapy. 

But  what  we  have  discussed  now  leaves  little  doubt 
as  to  the  necessary  decision.  The  physician  is  inter- 
ested in  the  mental  life  with  the  aim  of  producing  a 
certain  effect,  namely,  that  of  health.  Thus  the  men- 
tal life  of  the  whole  personality  comes  in  question 
for  him  as  belonging  to  a  chain  of  causes  and  effects; 
whichever  levers  he  may  move,  everything  is  to  be  a 
cause  which,  in  accordance  with  causal  laws,  is  to 
produce  a  certain  change.  Inner  life  is  thus,  in  the 
interests  of  medical  treatment,  necessarily  a  part  of  a 
causal  system.  This  means  the  standpoint  of  scien- 
tific psychology  is  the  only  adequate  one.  The  pur- 
posive view  of  inner  life  ought  not  to  be  in  question 
when  the  patient  enters  the  doctor's  office. 

To  characterize  the  difference,  it  may  be  said  at 
once  that  It  is  a  purposive  view  which  belongs  to  the 
minister.  If  the  minister  says  to  his  despairing 
parishioner,  "  Be  courageous,  my  friend,  and  be 
faithful,"  nothing  but  a  strictly  purposive  view  gives 
meaning  to  the  situation.  The  word  friend  indicates 
it,  that  one  subject  of  will  approaches  another  subject 
of  will,  with  the  intention  of  sympathy  and  under- 
standing of  the  attitude  of  the  other;  and  the  advice 


58  PSYCHOTHERAPY 

to  be  courageous  and  faithful  means  an  appeal  which 
has  its  whole  meaning  in  the  relation  to  aims  and 
ends.  The  speaker  and  the  hearer  are  both  moving 
in  a  sphere  of  will  relations,  purposes  and  ideals,  sin 
and  virtue,  hope  and  belief.  To  take  the  other  ex- 
treme: if  the  neurasthenic  in  his  state  of  depression 
and  in  his  feeling  of  inability  seeks  relief  from  the 
nerve  specialist,  he  too  may  say:  "My  friend,  be 
courageous  and  faithful,"  yet  his  words  have  an  en- 
tirely different  purpose.  They  are  not  appeals  to  a 
common  interest  of  belief;  they  are  subtle  tools  with 
which  to  touch  and  to  change  certain  psychophysical 
processes,  certain  states  in  mind  and  brain;  there 
each  word  is  a  sound  which  awakens  certain  mental 
associations,  and  these  associations  are  expected  to  be 
causes  of  certain  effects  and  these  effects  are  to  inhibit 
those  disturbing  states  of  emotional  depression.  If 
a  few  grains  of  sodium  bromide  were  to  produce  the 
same  effect,  they  would  be  just  as  welcome.  The 
whole  consideration  moves  in  a  sphere  in  which  only 
physiological  and  psychological  processes  are  happen- 
ing. Thus  the  physician  may  work  with  the  ideas  of 
religious  belief,  but  those  ideas  are  then  no  longer 
religious  values  but  natural  psychophysical  material, 
which  is  to  be  applied  whenever  it  appears  as  the 
right  means  to  secure  a  certain  effect. 

On  the  other  hand  the  minister  also  knows,  of 
course,  that  every  word  which  he  speaks  has  its  psy- 
chological effect,  but  he  abstracts  from  that  entirely, 
as  his  belief  should  appeal  directly  to  the  struggling 
will  of  the  man.  As  minister,  he  is  thus  not  a  psy- 


PSYCHOLOGY  AND  MEDICINE       59 

chologist.  He  works  with  moral  means;  the  phy- 
sician, with  causal  means.  The  view  which  the  doc- 
tor has  to  take  of  the  man  before  him  is  therefore 
thoroughly  psychological;  whereas  that  of  the  reli- 
gious friend  is  thoroughly  unpsychological,  or  better, 
apsychological.  Indeed  it  is  misleading,  or  at  least 
demands  a  special  kind  of  definition,  if  people  say 
that  the  minister  has  to  be  a  good  psychologist.  It 
is  just  as  misleading  as  the  claim,  which  we  hear  so 
often,  that  for  instance  Shakespeare  was  a  great  psy- 
chologist. No,  the  poet  deals  with  human  beings 
from  the  purposive  standpoint  of  life  and  the  mere 
resolving  of  complex  purposes  into  parts  of  purposes 
is  not  psychology  in  the  technical  sense  of  the  term. 
The  poet  makes  us  understand  the  inner  life,  but  he 
does  not  describe  or  explain  it;  he  makes  us  feel  with 
other  people,  but  he  does  not  make  those  feelings 
causally  understood.  The  realistic  novelists  some- 
times undertake  this  psychological  task,  but  they  are 
then  on  the  borderland  of  literature,  the  analysis  of 
their  heroes  becomes  then  a  psychological  one. 
Shakespeare  understood  human  beings  better  than 
anyone  and  therefore  the  men  and  women  whom  his 
imagination  created  are  so  fully  lifelike  that  the  psy- 
chologist may  feel  justified  in  using  them  as  material 
for  his  psychological  analysis,  but  Shakespeare  him- 
self did  not  enter  into  that  psychological  dissection; 
he  kept  the  purposive  point  of  view.  In  the  same 
way  certainly  the  minister — the  same  holds  true  for 
the  lawyer  or  the  tradesman  or  anyone  who  enters 
into  practical  dealings  with  his  neighbor — may 


60  PSYCHOTHERAPY 

resolve  complex  attitudes  of  will  into  their  compo- 
nents, but  each  part  still  remains  a  will  attitude  which 
has  to  be  understood  and  to  be  interpreted  and  to 
be  appreciated,  while  the  psychologist  would  take 
every  one  of  those  parts  as  a  conscious  content  to  be 
described  and  to  be  explained.  But  here  we  abstract 
from  the  purposive  relations.  Our  attention  belongs 
now  to  the  doctor's  dealing  with  man ;  for  him  cause 
and  effect  are  the  only  vehicles  of  connection.  Thus 
he  has  to  exclude  the  purposive  interpretation  of 
inner  life  and  has  to  understand  every  factor  involved 
from  a  psychological  point  of  view:  his  psycho- 
therapy must  be  thoroughly  applied  psychology. 

The  day  of  applied  psychology  is  only  dawning. 
The  situation  is  indeed  surprising.  The  last  three 
or  four  decades  have  given  to  the  world  at  last  a 
really  scientific  study  of  psychology,  a  study  not  un- 
worthy of  being  compared  with  that  of  physics  or 
chemistry  or  biology.  In  the  center  of  the  whole 
movement  stood  the  psychological  laboratory  with  its 
equipment  for  the  most  subtle  analysis  and  explana- 
tory investigation  of  mental  phenomena.  The  first 
psychological  laboratory  was  created  in  Leipzig, 
Germany,  in  1878.  It  became  the  parent  institu- 
tion for  laboratories  in  all  countries.  At  present, 
America  alone  has  more  than  fifty  psychological 
laboratories,  many  of  them  large  institutions  equipped 
with  precious  instruments  for  the  study  of  ideas  and 
emotions,  memories  and  feelings,  sensations  and 
actions.  Still  more  rapid  than  this  external  growth 
of  the  laboratory  psychology  was  the  inner  growth 


PSYCHOLOGY  AND  MEDICINE       61 

of  the  experimental  method.  It  began  with  simple 
experiments  on  sensations  and  impulses,  and  it  seemed 
as  if  it  would  remain  impossible  to  attack  with  the 
experimental  scheme  the  higher  and  more  complex 
psychical  structures.  But  just  as  in  physics  and 
chemistry  the  triumphal  march  of  the  experimental 
method  could  not  be  stopped,  one  part  of  the  psycho- 
logical field  after  another  was  conquered.  Attention 
and  memory,  association  and  inhibition,  emotion  and 
volition,  judgment  and  feeling  all  became  subjected 
to  the  scientific  scheme  of  experiment.  And  that 
was  all  supplemented  by  the  progress  of  physiological 
psychology,  pathological  psychology,  child  psychol- 
ogy, animal  psychology.  In  this  way  the  last  decades 
created  a  science  which  of  course  was  by  principle  a 
continuation  of  the  old  psychology,  but  yet  which  had 
good  reason  to  designate  itself  as  a  "  new  "  psy- 
chology. 

But  in  this  whole  development,  until  yesterday, 
the  curious  fact  remained  that  it  was  going  on  with- 
out any  narrow  contact  with  practical  life;  it  was  a 
science  for  the  scientist  and  measured  by  its  practical 
achievements  in  daily  life,  it  seemed  barren  and  un- 
productive. Psychology  was  studied  as  palaeontol- 
ogy and  Sanscrit  were  studied,  without  any  direct  re- 
lation to  the  life  which  surrounds  us.  And  yet  after 
all  it  deals  with  the  mental  facts  which  have  to  enter 
into  every  one  of  our  practical  deeds,  if  we  are  to 
consider  mental  life  from  a  psychological  point  of 
view.  The  psychologists  were  certainly  not  to  be 
blamed  for  sticking  to  their  theoretical  interests. 


62  PSYCHOTHERAPY 

More  than  that,  they  were  certainly  justified  in  their 
reluctance,  as  everything  was  in  the  making,  and  in- 
complete theories  can  easily  do  more  harm  than  good. 
But  slowly  a  certain  consolidation  has  set  in;  large 
sets  of  facts  have  been  secured,  and  psychology  seems 
better  prepared  to  become  serviceable  to  the  practical 
tasks.  On  the  other  hand,  it  has  been  noticeable  for 
some  time  that  not  a  few  of  the  psychological  results 
have  gone  over  into  unprofessional  hands  and  have 
been  thrown  on  the  market  places  and  have  been 
brought  into  many  a  home  where  no  one  knew  how 
to  deal  with  them  rightly.  Thus  the  need  seems 
urgent  that  the  psychologists  give  up  their  over- 
reserved  attitude  and  recognize  it  as  their  duty  to 
serve  the  needs  of  the  community. 

It  is  not  sufficient  for  that  end,  simply  to  take  odds 
and  ends  of  psychology  and  to  hand  them  over  to 
anyone  who  can  see  some  use  for  them.  We  must 
have  a  systematic  scientific  work  done  for  the  special 
purpose  of  adjusting  psychological  knowledge  to  the 
definite  practical  tasks  and  of  examining  the  psycho- 
logical facts  with  that  practical  end  in  view.  A 
science  must  be  developed  which  is  related  to  psychol- 
ogy as  engineering  is  related  to  physics  and  chemistry. 
Just  as  the  technological  laboratories  of  the  engineer 
bring  out  many  new  problems  which  the  physicist 
would  never  have  approached,  in  the  same  way  we 
may  expect  that  special  institutions  for  applied  psy- 
chology will  shape  the  psychological  inquiry  in  a  new 
way. 

Such  a  new  science  of  applied  psychology  of  course 


has  before  it  a  field  just  as  large  and  manifold  as  the 
field  of  technology,  where  physical  engineering, 
chemical  engineering,  mechanical  engineering,  and 
electrical  engineering  and  so  on  are  separated.  Such 
a  future  psychological  technology  would  deal,  for 
instance,  with  psychopedagogical  problems.  There 
belongs  everything  which  refers  to  the  psychology  of 
memory  or  attention,  of  discipline,  of  fatigue,  of 
habit,  of  imitation  or  effort ;  in  short,  all  those  mental 
factors  which  have  to  be  considered  whenever  the 
schoolchild  is  looked  on  from  a  causal  point  of  view. 
Further  there  is  the  psycholegal  field  where  the 
memory  and  the  perceptions,  the  suggestibility  and 
the  emotions  of  the  witness  are  to  be  studied,  where 
the  psychological  conditions  which  lead  to  crime,  the 
means  to  tap  the  hidden  thoughts  of  the  criminal,  the 
inhibitions  for  the  prevention  of  crime,  the  mental 
effects  of  punishment  and  similar  causal  processes 
must  be  determined.  There  are  the  psychoscientific 
problems  referring  to  psychological  influences  on  the 
observations  and  judgments  and  discriminations  of 
the  scholar  who  watches  the  stars  or  who  translates 
an  inscription.  There  are  the  psychoaesthetic  prob- 
lems where  the  task  is  to  examine  causally  the  factors 
which  lead  to  the  agreeable  effects  of  beautiful  sur- 
roundings, and  from  the  height  of  the  psychology  of 
aesthetics  in  painting  and  sculpture,  the  inquiry  may 
go  to  the  psychology  of  the  pleasant  effects  in  dress- 
making or  cooking.  There  are  the  large  groups  of 
psychotechnical  problems  where  the  effort  refers  to 
the  application  of  psychology  in  securing  the  best 


64  PSYCHOTHERAPY 

conditions  for  labor  and  industry  and  commerce.  It 
leads  from  the  mental  effects  of  signals  or  the  mental 
fatigue  in  mills  to  the  secrets  of  advertisements  and 
salesmanship.  There  are  especially  important  psy- 
chodiagnostical  studies  where  the  aim  is  to  determine 
the  individual  differences  of  man  by  experimental 
methods  and  to  make  use  of  them  for  the  selection  of 
the  right  man  for  the  right  place.  There  are  psycho- 
social  problems  where  we  examine  the  psychological 
factors  which  have  to  enter  into  public  movements, 
into  social  reforms,  into  legislation  and  into  politics. 
In  this  way  new  and  ever  new  groups  may  be  added ; 
every  time  the  central  thought  is :  how  far  can  causal 
psychological  knowledge  help  us  to  reach  a  certain 
end?  Together  with  these  forms  of  applied  psy- 
chology, we  find  the  psychomedical  problems;  here 
belongs  everything  which  allows  the  application  of 
causal  psychology  in  the  interests  of  health. 

It  might  be  answered  that  this  demand  for  a 
strictly  causal  point  of  view  can  hardly  be  fulfilled, 
because,  if  I  am  acting, — it  may  be  in  the  interest  of 
education  or  law  or  technique  or  medicine, — I  must 
always  have  an  end  in  view  and  to  select  such  an  end 
belongs  after  all  to  my  system  of  purposes.  If  I  am 
a  teacher  and  have  to  deal  with  children,  then  it  may 
be  said  that  after  all,  my  knowledge  of  causal  psy- 
chology cannot  help  me  if  I  am  uncertain  for  which 
ideals  I  want  to  educate  these  children.  Psychology 
can  tell  me  that  I  need  these  means,  if  I  want  to  reach 
certain  effects,  but  I  cannot  find  out  by  psychology 
which  effects  are  desirable.  Psychology  may  tell  me 


PSYCHOLOGY  AND  MEDICINE       65 

how  to  make  a  good  business  man  or  a  good  scholar 
or  a  good  soldier  out  of  my  boy,  but  whether  I  want 
him  to  become  a  soldier  or  a  merchant  I  must  de- 
cide for  myself  with  reference  to  general  aims,  and 
that  leads  me  back  to  the  purposive  view  of  life. 
Such  argument  is  entirely  correct.  Yes,  it  is  evident 
that  it  is  in  full  harmony  with  our  whole  understand- 
ing of  the  purpose  of  psychology.  We  saw  that  psy- 
chology with  its  causal  treatment  of  man's  mind  does 
not  express  the  immediate  reality,  but  is  a  certain  recon- 
struction which  allows  a  calculation  of  certain  effects. 
Thus  it  is  itself  a  system  existing  for  a  subject  who 
has  certain  ends  in  view.  The  whole  causal  view  of 
man  is  thus  a  tool  in  the  service  of  the  purposive  man. 
This  is  the  reason  why  it  is  indeed  utterly  absurd  to 
think  that  psychology  can  ever  help  us  to  determine 
which  end  we  ought  to  reach. 

In  education,  for  instance,  very  many  different  ends 
might  be  reached;  psychology  cannot  decide  any- 
thing. The  decision  as  to  the  aims  of  education 
must  be  made  by  ethics,  which  indeed  takes  not  a 
causal  but  a  purposive  attitude.  Only  after  ethics 
has  selected  the  aim,  psychology  can  teach  us  how  to 
reach  it.  Of  course  this  principle  must  hold  for  the 
physician  too.  All  his  causal  dealing  with  the  mind 
presupposes  that  he  has  selected  a  certain  end  in 
harmony  with  his  purpose.  The  only  difference  is 
that,  in  the  case  of  the  physician,  there  can  be  no 
possible  doubt  as  to  the  desirable  end;  what  he  aims 
at  is  a  matter  of  course,  namely,  the  health  of  the 
patient.  To  desire  the  health  of  the  sufferer  is  thus 


66  PSYCHOTHERAPY 

itself  a  function  which  belongs  entirely  to  the  pur- 
posive view  of  the  world,  and  only  in  the  interest  of 
this  purpose  does  the  physician  apply  his  knowledge 
of  psychology  or  of  the  causal  sciences  of  physics, 
physiology,  and  chemistry.  Indeed  only  with  this 
limitation  have  we  the  right  to  say  that  the  psycho- 
therapist takes  the  causal, — and  that  means  the  psy- 
chological,— view  of  his  patient.  As  far  as  he  de- 
cides to  take  care  of  the  health  of  his  patient,  this 
decision  itself  belongs  to  the  purposive  world  and  to 
his  moral  system.  The  physician  is  thus  ultimately 
just  like  the  minister  and  just  like  anyone  who  deals 
with  his  neighbor,  a  purposive  worker ;  but  while  the 
minister,  for  instance,  remains  on  this  purposive 
track,  the  physician  puts  a  causal  system  into  the 
service  of  his  purpose.  He  knows  the  end,  and  his 
whole  aim  is  to  apply  his  causal  knowledge  of  the 
physical  and  psychical  world  to  the  one  accepted  end 
of  restoring  the  health  of  the  patient.  He  has  to 
ask  thus  in  general:  what  has  psychology  to-day  to 
offer  which  can  be  applied  in  the  interests  of  medi- 
cine? 

It  would  be  an  inexcusable  narrowness  to  confine 
that  chapter  of  applied  psychology  which  is  to  deal 
with  the  psychomedical  problems  to  the  work  of  psy- 
chotherapy. Medicine  involves  diagnosis  of  illness 
as  well  as  therapeutics.  Between  the  recognition  and 
the  treatment  of  the  illness  lies  the  observation  of  its 
development  and  all  this  is  preceded  by  steps  towards 
the  prevention  of  illness.  In  every  one  of  these 
regions,  psychology  may  be  serviceable.  Psycho- 


PSYCHOLOGY  AND  MEDICINE       67 

therapy  is  thus  only  one  special  part  of  psychomedi- 
cine.  But  the  situation  becomes  still  more  complex 
by  the  fact  that  the  illness  to  be  treated  or  the  dis- 
turbance to  be  removed  may  stand  in  different  re- 
lations to  the  psychophysical  processes.  The  illness 
may  be  a  disturbance  in  the  psychophysical  brain  parts, 
or  it  may  belong  to  other  brain  parts  which  are  only 
in  an  indirect  way  under  the  influence  of  mental  states 
or  which  are  themselves  indirectly  producing  changes 
in  the  mental  life.  And  finally  the  disturbance  may 
exist  outside  of  the  brain  in  any  part  of  the  body, 
and  yet  again  through  the  medium  of  brain  and 
nervous  system  it  may  produce  effects  in  the  mind  or 
be  open  to  the  influence  of  the  mind.  Thus  we  have 
entirely  different  groups  of  medical  interests  and  it 
would  be  superficial  to  ignore  the  differences. 

Both  psychodiagnostic  and  psychotherapeutic 
studies  must  be  devoted  to  cases  in  which  the  mind 
itself  is  abnormal,  further  to  cases  in  which  the  nor- 
mal minds  registers  the  abnormalities  in  other  parts 
of  the  body,  and  finally  to  cases  in  which  the  normal 
mind  influences  abnormal  processes  in  the  body. 
These  latter  two  cases  have  to  be  subdivided  into 
those  where  the  bodily  disturbance  still  lies  in  the 
brain  parts  and  those  where  it  lies  outside  of  the 
brain.  But  the  situation  becomes  still  more  com- 
plex by  the  mutual  relations  of  those  various  proc- 
esses. The  impulse  to  take  morphine  injections 
may  have  reached  the  character  of  a  mental  obsession 
and  thus  represent  an  abnormality  of  the  mind,  but 
yielding  to  it  produces  at  the  same  time  disturbances 


68  PSYCHOTHERAPY 

in  the  whole  body  which  thus  become  again  external 
sources  for  abnormal  experiences  in  otherwise  normal 
layers  of  the  mind. 

Of  course  the  interest  of  the  psychologist  as  such 
remains  always  related  to  the  psychological  factor, 
but  the  relation  of  the  psychological  factor  itself  to 
the  total  disturbance  may  be  of  most  different  char- 
acter. If  I  diagnose  or  treat  the  fixed  idea  of  a  psy- 
chasthenic,  the  psychological  factor  itself  represents 
the  disturbance.  On  the  other  hand,  if  I  study  the 
pain  sensations  of  a  patient  who  suffers  from  a  dis- 
ease of  the  spinal  cord,  then  the  sensations  them- 
selves, the  only  psychological  factor  in  the  case,  are 
only  indications  of  a  disease  which  belongs  to  an  en- 
tirely different  physical  region ;  the  mind  itself  is  nor- 
mal. Or,  on  the  other  hand,  if  I  try  to  educate  a 
sufferer  from  locomotor  ataxia  to  develop  his  walk- 
ing by  building  up  in  his  mind  new  motor  ideas 
to  regulate  his  coordinated  movements,  the  mind 
again  is  entirely  normal  but  the  physician  needs  his 
psychology  on  account  of  the  influence  which  the 
mind  has  on  the  bodily  system.  Again,  we  must  in- 
sist that  psychomedicine  covers  this  whole  ground. 
Wherever  a  psychical  factor  enters  into  the  calcula- 
tions of  the  physician  either  by  reason  of  its  own 
abnormality  or  by  its  relation  as  effect  or  as  cause  to 
a  diseased  part  of  the  body  in  the  brain  or  without, 
there  we  have  a  psychomedical  task,  and  as  far  as  it 
is  therapeutic,  we  have  psychotherapy. 

The  psychodiagnostic  research  lies  outside  of  the 
compass  of  our  book,  but  we  cannot  emphasize  suffi- 


PSYCHOLOGY  AND  MEDICINE       69 

ciently  the  great  importance  which  belongs  to  that 
work.  Moreover,  just  in  the  field  of  psychodiagnos- 
tics,  the  methods  of  the  modern  experimental  psycho- 
logical laboratory  are  most  promising  and  successful. 
Let  us  not  forget  that  we  deal  with  such  psycholog- 
ical factors  even  when  we  test  the  functions  of  eye 
and  ear  and  skin  and  nose  by  examining  the  sensa- 
tions and  perceptions.  The  oculist  who  analyzes  the 
color  sensations  of  a  patient  and  the  aurist  who  finds 
defects  in  the  hearing  of  the  musical  scale  and  dis- 
covers that  certain  pitches  cannot  be  discriminated, 
is  certainly  dealing,  for  diagnostic  purposes,  with  the 
material  that  the  psychological  laboratory  has  sifted 
and  studied.  Even  that  sensation  symptom  which 
enters  into  so  many  diseases,  the  sensation  of  pain, 
belongs  certainly  within  the  compass  of  the  psychol- 
ogist and  it  is  only  to  be  regretted  that  the  systematic 
study  of  the  pain  sensations,  mostly  for  evident  prac- 
tical reasons,  has  been  much  neglected  in  the  psycho- 
logical laboratory. 

The  psychologists  have  been  at  work  all  the  more 
eagerly  in  the  fields  of  association  and  memory,  atten- 
tion and  emotion,  habit  and  volition,  distraction  and 
fatigue.  Here  subtle  methods  have  been  elaborated, 
methods  which  surely  common  sense  cannot  supply, 
and  which  showed  differences  of  mental  behavior 
with  the  exactitude  with  which  the  microscope  reveals 
the  hidden  differences  of  form.  If  physicians  are 
slow  in  accepting  the  help  which  the  psychological 
laboratory  can  furnish,  it  may  be  in  good  harmony 
with  the  desirable  conservative  policy  in  medicine,  but 


70  PSYCHOTHERAPY; 

finally  the  time  must  come  when  this  instinctive 
resistance  against  new  methods  will  be  overcome. 
The  recent  attachment  of  psychological  laboratories 
to  certain  leading  psychiatric  clinics  is  a  most  promis- 
ing symptom.  Yet  the  diagnostic  studies  with  the 
means  of  the  psychological  laboratory  cannot  be  con- 
fined to  the  cases  of  mental  disease.  The  mild  ab- 
normalities of  the  mind,  and  especially  the  nervous 
disturbances  which  exist  outside  the  field  of  insanity, 
demand  this  support  of  psychology  much  more.  And 
even  the  normal  personality  will  be  more  safely  pro- 
tected from  disease  and  from  social  dangers  for  its 
mental  constitution  if  the  resources  of  experimental 
psychology  are  employed.  The  more  we  know  of 
the  psychological  constitution  of  the  individual,  the 
more  we  can  foresee  the  development  which  is  to  be 
hoped  for  or  feared  and  which  may  be  encouraged 
or  retarded. 

The  psychologist  may  determine,  for  instance,  the 
degree  of  attention  with  its  resistance  against  dis- 
tracting stimuli,  the  power  of  memory  under  various 
conditions  and  on  various  material,  the  mental  ex- 
citability and  power  of  discrimination,  the  quickness 
and  correctness  of  perception,  the  chains  of  associa- 
tions, the  rapidity  of  the  associative  process  for 
various  groups,  the  types  of  reaction,  the  forming  of 
habits  and  their  persistence,  the  conditions  of  fatigue 
and  of  exhaustion,  the  emotional  expressions  and  the 
emotional  stability,  the  time  needed  for  recreation 
and  the  resistance  against  drugs,  the  degree  of  sug- 
gestibility and  the  power  of  inhibition :  and  every  re« 


PSYCHOLOGY  AND  MEDICINE       71 

suit  in  any  of  these  lines  may  contribute  to  the 
diagnosis  and  prognosis  of  cases.  The  chronoscope 
here  measures  the  reaction  times  and  association 
times  in  thousandths  of  a  second;  the  kymograph,  by 
the  help  of  the  sphygmograph,  writes  the  record  of 
the  pulse  and  its  changes  in  emotional  states,  while 
the  pneumograph  records  the  variations  of  breathing, 
and  the  plethysmograph  shows  the  changes  in  the 
filling  of  blood  vessels  in  the  limbs  which  is  im- 
mediately related  to  the  blood  supply  of  the  brain. 
Here  belongs  also  the  ergograph,  which  gives  the 
exact  record  of  muscular  work  with  all  the  influences 
of  will  and  attention  and  fatigue,  the  automatograph 
which  writes  the  involuntary  movements,  especially 
also  the  galvanoscope  which  may  register  the  influ- 
ence of  ideas  and  emotions  on  the  glands  of  the  skin, 
and  thus  lead  to  an  analysis  of  repressed  mental 
states,  and  hundreds  of  other  instruments  which  are 
used  in  the  psychological  laboratory. 

Yet  it  would  be  misleading  to  think  only  of  com- 
plex apparatus  when  experimental  psychology  is  in 
question.  An  experiment  is  given  whenever  the  ob- 
servation is  made  under  conditions  which  are  arti- 
ficially introduced  for  the  purpose  of  the  observation. 
Thus  there  is  no  need  of  the  physical  instrument.  If 
I  bring  a  spoonful  of  soup  to  my  mouth  at  dinner 
and  I  become  interested  in  the  combination  of 
warmth  sensation  and  touch  sensation  and  taste  sen- 
sation and  smell  sensation,  then  I  have  performed  an 
experiment  if  I  take  one  more  spoonful  of  soup  just 
for  the  purpose  of  the  observation.  The  physician 


72  PSYCHOTHERAPY 

too  may  carry  out  important  psychological  experi- 
ments, without  needing  the  outfit  of  a  real  laboratory. 
Association  experiments,  for  instance,  promise  to  be- 
come of  steadily  growing  importance.  To  make 
them  serviceable  to  the  problems  of  his  office,  nothing 
but  a  subtle  psychological  understanding  is  needed, 
inasmuch  as  any  routine  work  schematically  applied 
to  every  case  alike  would  be  utterly  useless.  Give 
your  man  perhaps  a  hundred  words  and  let  him  speak 
the  very  first  word  which  comes  to  his  mind  when  he 
hears  the  given  ones.  You  call  rose,  and  he  may  say 
red  or  flower  or  lily  or  thorn;  you  call  frog  and  he 
may  answer  pond  or  turtle  or  green  or  jump,  and  if 
you  choose  your  hundred  words  with  psychological 
insight,  his  hundred  answers  will  allow  a  full  view  of 
his  mental  makeup.  This  is  an  experiment  which 
does  not  require  any  instruments  at  all  but  a  man's 
subtle  analysis  of  the  replies.  That  is  not  seldom 
sufficient  to  secure  the  diagnosis  of  complex  mental 
variations.  The  method  yields  still  more  if  the  time 
for  such  a  reply  is  measured,  but  there  again  not  the 
costly  chronoscope  of  the  laboratory  is  indispensable ; 
a  simple  stop  watch  which  gives  the  fifths  of  a  second 
would  be  fully  sufficient  for  all  practical  purposes. 
From  such  simple  facts  of  the  mental  inventory  the 
association  experiments  may  lead  to  complex  questions 
which  slowly  may  disentangle  the  confused  ideas,  for 
instance,  of  a  dementia  praecox,  and  thus  lead  to 
subtle  differential  diagnosis. 

The  psychological  laboratory  alone  can  also  elabo- 
rate the  methods  of  studying,  for  instance,  the  feeble- 


PSYCHOLOGY  AND  MEDICINE       73 

minded  with  all  the  individual  variations.  New  and 
ever  new  methods  have  been  tried;  the  memory  was 
tested  by  reading  and  repeating  figures  or  letters,  or 
colored  papers  were  shown  or  cardboards  of  different 
forms  or  nonsense  syllables,  and  the  powers  of 
remembering  were  studied.  Or  the  accuracy  of  arm 
movements  was  examined,  or  the  quickness  of  under- 
standing associated  words,  or  the  success  in  planning 
a  complex  movement  like  throwing  a  ball  at  a  target, 
or  the  tapping  of  a  key  in  the  rhythm  of  a  metro- 
nome, or  the  discrimination  and  recognition  of  the 
pieces  in  the  game  of  dominoes  and  many  another 
scheme.  The  laboratory  has  to  analyze  the  con- 
ditions for  such  methods  and  the  psychologist  has  to 
prepare  the  means  for  the  use  of  the  physician,  just  as 
the  chemist  has  to  prepare  the  sleeping  powders.  In 
a  similar  way  the  laboratory  may  furnish  means  to 
analyze  the  mental  disturbances  by  a  comparison  with 
the  experimental  results  of  artificial  influences,  for  in- 
stance, of  over-fatigue  or  half-sleep,  of  drugs  or  alco- 
hol, of  poisons  and  emotional  excitements.  The  psy- 
chological resolving  of  the  mental  symptoms  may  of 
course,  in  the  same  way,  furnish  the  diagnosis  where 
the  mental  variation  is  only  a  distant  effect  of  a  bodily 
ailment.  The  changes  in  the  emotions,  for  instance, 
may  lead  to  the  recognition  of  a  heart  disease;  lack 
of  attention  may  be  a  hint  of  the  overgrowth  of  the 
adenoids;  irritability  or  apathy  or  delirious  character 
of  the  mental  behavior  may  indicate  whether 
uraemic  acid  is  in  the  system  or  an  infectious  disease : 
anaemia  and  undernutrition  may  be  diagnosed  and  the 


74  PSYCHOTHERAPY 

psychology  of  fever  demands  too  a  much  closer 
analysis  with  the  means  of  the  psychological  labora- 
tory than  it  has  received  so  far. 

We  have  not  spoken  as  yet  about  those  psycho- 
logical methods  which  themselves  introduce  abnormal 
mental  states  like  hypnotism,  and  which  also  not 
seldom  are  only  means  for  diagnostic  purposes.  The 
hypnotic  state  may  bring  to  memory  forgotten  ex- 
periences of  which  the  physiological  effects  may  have 
lasted  in  the  brain  and  which  may  have  brought  injury 
to  the  psychophysical  system.  Hypnotic  inquiry  can 
thus  lead  to  the  recognition  of  the  first  causes  in  many 
hysterical  states  and  where  hypnotism  is  not  the  best 
adjusted  tool,  a  certain  dreamlike  staring  may  be 
more  effective.  We  have  to  return  to  much  of  that 
later  in  full  detail  because  just  for  instance  in  hyste- 
ria, the  clear  recognition  of  the  sources  and  of  the 
character  of  the  disease  may  at  the  same  time  prove 
to  be  in  itself  the  right  starting  point  for  curative 
treatment. 

We  have  spoken  so  far  only  about  the  relations  of 
psychology  and  medicine  from  the  point  of  view  of 
diagnosis;  the  relations  from  the  point  of  view  of 
therapy  will  make  up  the  second  part  of  this  book. 
We  shall  describe  the  methods  and  the  results,  the 
possibilities  and  the  limitations  with  manifold  detail. 
That  is  the  chief  topic  of  this  volume.  All  that  is 
needed  to  prepare  for  this  principal  problem  is  on 
the  one  side  a  preparatory  clearing  up  of  some  funda- 
mental conceptions,  especially  of  those  two  which 
have  played  the  chief  role  in  the  whole  discussion, 


PSYCHOLOGY  AND  MEDICINE       75 

namely  the  subconscious  and  suggestion.  And  on 
the  other  side,  we  may  consider  at  first  some  funda- 
mental discriminations  which  steadily  influence  the 
inquiries  and  controversies  in  the  field.  I  think  of 
the  difference  between  normal  and  abnormal  mental 
states,  between  psychical  and  physical  facts  in  psy- 
chotherapy, between  functional  and  organic  diseases, 
and  to  return  to  our  starting  point,  between  mental 
and  moral  influences. 

Every  curative  effort  presupposes  that  the  normal 
state  of  health  has  been  lost  and  that  a  diseased  state 
has  set  in.  Yet  the  mental  analysis  suggests  still  less 
than  the  bodily  inquiry,  just  where  the  normal  func- 
tioning is  really  lost.  It  would  be  easy  to  draw  a 
demarcation  line  if  the  pathology  of  the  mind  intro- 
duced any  mental  features  which  are  unknown  in  our 
normal  existence,  but  the  opposite  is  true.  No  men- 
tal disease  introduces  elements  which  do  not  occur  in 
the  sphere  of  health.  A  degenerated  brain  cell  looks 
differently  under  the  microscope  from  a  normal  one, 
but  the  ideas  of  a  paranoiac,  the  emotion  of  a  maniac, 
the  volition  of  a  hysteric,  the  memory  idea  of  a  para- 
lytic is  each  in  its  own  structure  not  different  from 
such  elements  in  any  one  of  us.  The  total  change  lies 
thus  only  in  the  proportion;  there  is  too  much  or  too 
little  of  it.  The  pathological  mental  life  is  like  a 
caricature  of  a  face — each  feature  is  contained,  as  in 
the  ordinary  portrait,  but  the  proportion  is  distorted, 
there  is  too  much  or  too  little  of  chin  or  of  nose. 
But  who  can  indicate  exactly  the  point  where  the  dis- 
tortion of  the  features  constitutes  a  caricature? 


76  PSYCHOTHERAPY 

Every  grotesque  change  in  the  relations  ruins  the 
healthy  state :  what  makes  us  sure  that  the  harmony 
of  health  is  spoiled? 

Certainly  we  cannot  settle  it  by  mere  statistics. 
The  norm  never  means  merely  a  majority.  Even  if 
the  overwhelmingly  larger  part  of  mankind  suffered 
from  phthisis,  the  few  who  were  free  from  it  would 
be  recognized  as  well  and  all  the  others  would  be 
considered  ill.  In  mental  life  still  more,  no  one  ought 
to  propose  that  the  exceptional  function  is  the 
symptom  of  disease.  The  few  persons  who  never 
had  a  dream  in  their  lives  differ  much  in  their  mental 
experience  from  the  large  majority  and  yet  their 
peculiarity  is  certainly  not  a  symptom  which  needs 
curative  treatment.  The  only  real  test  of  health  is 
the  serviceableness  to  the  needs  of  life!  We  have  an 
unhealthy  state  of  the  personality  before  us  wherever 
the  equilibrium  of  the  human  functions  is  disturbed 
in  a  way  which  diminishes  the  chances  of  existence, 
and  the  seriousness  of  the  ailment  depends  upon  the 
degree  of  this  diminishing  power.  Seen  from  a 
strictly  psychological  point  of  view,  we  must  expect 
thus  a  broad  borderland  region  between  the  entirely 
normal  well-balanced  mental  life  and  that  unbalanced 
disorder  of  functions  which  really  interferes  with 
the  chance  for  self-protection  and  effectiveness.  That 
the  melancholic  who  declines  to  take  any  nourishment, 
or  the  paranoiac  who  misjudges  his  surroundings, 
is  unable  to  secure  by  his  own  energies  the  safety  of 
his  life  cannot  be  doubted.  The  balance  is  com- 
pletely destroyed  and  the  will  and  the  intellect  of  the 


PSYCHOLOGY  AND  MEDICINE       77 

physician  and  of  the  nurse  must  be  substituted  for  his 
own  mental  powers,  if  his  life  is  to  be  prolonged  at 
all.  But  the  misjudgment  and  the  depression  of  the 
insane  are  only  an  exaggeration  of  that  which  may 
occur  in  any  man. 

There  are  therefore  thousands  of  steps  which  lead 
from  the  normal  error  or  regret  to  the  destructive 
disturbance.  Everyone  knows  persons  whose  pes- 
simistic temperament  makes  them  inclined  to  an  over- 
frequent  depression,  or  others  whose  silly  disposition 
brings  out  constantly  those  emotional  tendencies 
which  the  maniac  shows  in  an  exaggerated  degree. 
The  stupid  mind  shows  those  lacks  of  association  and 
connection  which  reach  their  maximum  degree  in  the 
mind  of  the  idiot.  We  know  from  daily  life  the 
timid,  undecided  man  who  cannot  come  to  a  will  im- 
pulse; the  hasty  man  who  rushes  towards  decisions; 
the  inattentive  man  who  can  never  focus  his  conscious- 
ness ;  and  the  overattentive  man  who  can  never  dismiss 
any  subject;  the  indifferent  man  on  whom  nothing  pro- 
duces evident  impression  and  feeling;  the  oversen- 
sitive man  who  reacts  on  slight  impressions  with  ex- 
aggerated emotion;  and  yet  every  one  of  such  and  a 
thousand  similar  variations,  needs  only  the  projection 
on  a  larger  scale  to  demonstrate  a  mental  life  which 
is  self-destructive.  The  silly  girl  and  the  stupid  boy, 
the  man  who  has  the  blues  and  the  reckless  creature, 
are  certainly  worse  equipped  for  the  struggles  of 
existence  than  those  who  are  intellectually  and  emo- 
tionally and  volitionally  well-balanced.  They  will 
take  wrong  steps  in  life,  they  may  be  unsuccessful, 


78  PSYCHOTHERAPY 

their  stupidity  may  lead  them  to  the  poorhouse, 
their  recklessness  may  lead  them  to  the  penitentiary. 
And  yet  we  do  not  speak  of  them  as  patients  because 
their  disproportionate  mental  features  may  be  suf- 
ficiently corrected  by  other  mental  states  which  are 
perhaps  more  strongly  developed. 

Further,  inasmuch  as  human  life  just  in  its  mental 
functions  is  related  to  its  social  surroundings,  much 
must  depend  on  the  external  conditions,  whether  the 
disproportion  and  abnormality  has  to  be  treated  as 
pathological.  The  mind  which  may  find  perhaps  its 
way  under  the  most  simple  rural  conditions  would  be 
unable  to  protect  life  under  the  complex  conditions 
of  a  great  city.  The  man  who  in  certain  surround- 
ings may  appear  a  crank  has  to  be  treated  as  a  patient 
in  a  different  set  of  life  conditions.  Wherever  psy- 
chotherapeutic  work  is  in  question,  perhaps  nothing 
is  more  important  than  to  keep  steadily  in  mind  this 
continuity  between  normal  and  abnormal  mental  fea- 
tures. The  mental  disturbance  must  constantly  be 
looked  upon  as  a  change  of  proportions  between  func- 
tions which,  as  such,  belong  to  every  normal  life. 
We  have  to  train  and  to  develop,  and  thus  to  re- 
enforce,  that  which  is  too  weak,  and  we  have  to  drain 
off  and  to  suppress  and  to  inhibit  that  which  is  too 
strong. 

Yet  just  this  functional  view  of  disease  must  re- 
mind us  strongly  from  the  beginning  that  it  would  be 
utterly  in  vain  to  draw  any  demarcation  line  between 
psychical  disturbances  and  physical  ones.  We  have 
seen  from  the  start  that  from  the  point  of  view  of 


PSYCHOLOGY  AND  MEDICINE       79 

physiological  psychology,  there  can  be  no  psychical 
process  without  an  accompanying  physiological  proc- 
ess in  the  brain.  Every  disturbance  in  mental 
actions  is  thus  at  the  same  time  a  disturbance  in  the 
equilibrium  of  nervous  functions.  Yet  that  alone 
would  not  exclude  the  possibility  of  considering  some 
diseases,  for  instance,  exclusively  from  the  mental 
side,  and  we  should  be  justified  in  doing  so  if  those 
parts  of  the  brain  which  are  the  seat  of  the  mental 
processes  could  remain  in  the  diseased  state  without 
influence  on  other  parts  of  the  nervous  system  and 
of  the  whole  body.  In  such  a  case  it  would  indeed 
be  sufficient  to  consider  the  psychophysical  dis- 
turbance from  the  psychological  point  of  view  only, 
that  is,  to  speak  of  the  disease  as  a  disorder  of  in- 
tellect, of  emotion  or  will,  without  thinking  of  changes 
in  the  brain  cells.  But  such  isolation  does  not  exist 
in  nature.  Not  only  the  bodily  factors  like  nutrition 
and  circulation  and  sexual  functions  have  a  thou- 
sandfold influence  on  the  psychophysical  processes, 
and  these  in  turn  change  the  vegetative  functions  of 
the  body,  but  especially  the  other  parts  of  the  brain 
and  nervous  system  can  be  affected  in  most  different 
ways.  If  we  want  to  consider  whether  a  certain 
variation  of  the  personality  demands  curative  treat- 
ment, we  certainly  cannot  confine  ourselves  to  the 
mental  variations.  They  are  after  all  only  parts  of 
the  whole  group  of  changes  in  the  organism  and  are 
thus  symptoms  of  a  disease  which  has  to  be  studied  in 
its  totality.  The  mental  symptoms  alone  may  be 
relatively  slight  variations,  which  in  themselves 


8o  PSYCHOTHERAPY 

might  be  sufficiently  balanced  not  to  disturb  the 
equilibrium  of  life,  and  yet  they  may  be  symptoms  of 
a  brain  disturbance  which  as  a  whole  must  interfere 
with  the  safety  of  life.  On  the  other  hand,  mental 
life  may  appear  like  a  chaos  and  yet  the  disturbance 
may  be  the  symptom  of  merely  a  slight  brain  affection 
and  the  treatment  of  the  mental  symptoms  in  their 
apparent  severity  would  be  a  useless  effort.  The 
mental  disturbance,  for  instance,  of  the  intoxicated 
or  the  hashish  smoker,  even  the  delirium  of  the 
feverish,  does  not  suggest  a  fight  against  the  mental 
symptoms  during  the  attack. 

On  the  whole,  there  is  a  far-reaching  independence 
between  the  apparent  mental  variations  and  the 
seriousness  of  the  brain  affection.  Light  hysteric 
states  may  produce  a  strong  absenting  of  the  mind 
while  severe  epileptic  conditions  of  the  brain  may 
be  accompanied  by  very  slight  mental  changes. 
Every  neurasthenic  state  may  play  havoc  with  mental 
life,  while  grave  brain  destructions  may  only  shade 
slightly  the  character  or  the  intellect.  To  deal  with 
the  mental  changes  as  if  they  belonged  to  a  sphere  by 
itself,  to  the  soul  which  is  well  or  ill  through  its  own 
independent  alterations  without  steadily  relating  the 
changes  to  the  total  organism,  leads  therefore  neces- 
sarily to  failure.  The  mindj'gflects  only  symptoms 
of  the  disease;  the  disease  itself  belpngsjdwjj[sj:o 
"the  organism! Psychotherapy  has  sUffered  too  much 
FronTthe^rjel i e f  that  the  removal  of  mental  symptoms 
is  a  cure  of  disease. 

Certainly  the  psychophysical  symptoms  may  often 


PSYCHOLOGY  AND  MEDICINE       81 

stand  in  the  foreground  of  the  disease,  and  in  that 
case  it  may  be  left  to  the  special  needs  whether  we 
deal  with  them  as  psychical  or  as  physical  changes. 
Even  the  patient  may  be  made  to  see  them  in  one  or 
the  other  way  in  accordance  with  his  special  needs. 
To  tell  him  that  his  brain  cells  are  in  disorder  and 
that  they  can  be  cured  will  be  the  right  thing  for  him 
who  takes  only  the  introspective  view  of  his  suffering 
and  is  in  despair  because  his  own  will  seems  power- 
less to  overcome  those  mental  changes.  For  the 
next  patient,  the  opposite  may  be  wiser.  The  belief 
that  his  brain  is  ill  may  have  induced  him  to  give  up 
effort  of  the  will  instead  of  helping  along  by  steady 
self-suggestion.  He  will  be  helped  more  if  he  under- 
stands that  his  mind  is  working  wrongly.  But  the 
full  truth  is  that  both  mind  and  body  are  in  disorder; 
the  function  of  the  disturbed  brain  cells  accompanies 
the  ineffective  will,  and  to  reenforce  the  will  means  to 
bring  into  equilibrium  again  the  disturbed  brain  cells. 
For  the  psychotherapist  the  temptation  of  giving  the 
attention  to  the  mental  symptoms  only  is  strong.  The 
more  firmly  the  physician  sticks  to  the  standpoint  of 
psychophysiology,  the  better  he  will  see  ailment  and 
cure  in  their  right  proportion. 

This  demand  for  the  consideration  of  the  whole 
personality,  mind  and  body,  ought  not  to  be  in- 
fluenced by  the  popular  separation  between  organic 
and  functional  diseases.  If  we  call  organic  diseases 
of  the  mind  those  in  which  the  mental  disturbance  is 
the  accompaniment  of  a  brain  disturbance,  and  func- 
tional those  in  which  no  brain  disturbance  exists,  we 


8,2  PSYCHOTHERAPY 

leave  entirely  the  ground  of  modern  psychology.  As 
soon  as  we  believe  that  the  mind  can  be  disturbed 
without  a  change  in  the  functions  of  the  brain,  we 
give  away  all  that  which  has  brought  scientific  order 
into  the  study  of  psychological  existence.  Every 
mental  disturbance  corresponds  to  a  disorder  in  the 
brain's  functions.  But  there  cannot  be  a  change  in 
the  functions  of  the  brain  without  a  change  in  its 
structure.  Thus  we  must  claim  that  all  those  so- 
called  functional  disturbances  like  neurasthenia  and 
hysteria,  fixed  ideas  and  obsessions,  phobias  and  dis- 
sociations of  the  personality,  as  well  as  the  typical 
insane  states  of  the  maniac  or  paranoiac  have  their 
basis  in  a  pathological  change  of  the  anatomical 
structure  of  the  brain.  This  postulate  cannot  be  in- 
fluenced by  the  fact  that  the  microscope  has  been  un- 
able to  detect  the  character  of  most  of  these  changes. 
Of  course  all  this  does  not  exclude  its  being  per- 
fectly justifiable  to  separate  those  diseases  for  which 
a  definite  destruction  of  the  brain  parts  can  be  de- 
tected, as  in  paralysis  of  the  brain,  from  those  where 
that  is  impossible.  We  may  also  expect  that  those 
disturbances  in  the  brain  which  we  cannot  as  yet 
make  visible,  may  allow  more  easily  an  organic  re- 
pair and  thus  a  restoration  to  the  normal  functions. 
Just  as  a  disjointed  arm  may  be  brought  to  function 
quickly  again,  a  broken  arm  slowly,  an  amputated 
arm  never,  each  brain  cell  too  may  suffer  lesions 
which  are  reparable  in  different  degrees.  But  it  is 
evident  that  it  remains  then  an  entirely  empirical 
question  whether  the  invisible  damage  allows  repair 


PSYCHOLOGY  AND  MEDICINE       83 

or  not.  We  have  no  right  to  say  that  where  the 
destruction  cannot  be  seen  under  the  microscope  there 
is  no  organic  change  and  the  disturbance  is  therefore 
only  a  psychical  one  and  can  be  removed  by  mental 
means.  All  changes  are  physical  and  experience  has 
to  decide  whether  they  are  accessible  to  psychological 
influences  or  not.  States  like  epilepsy  may  not  allow 
any  recognition  of  definite  brain  destruction  and  are 
yet  on  the  whole  inaccessible  to  mental  influence, 
while  many  a  brain  disturbance  with  visible  alter- 
ations, resulting  perhaps  from  anaemia  or  hyperasmia, 
may  be  caused  to  disappear.  If  on  the  other  hand 
we  say  that  we  can  cure  with  psychotherapeutic  means 
only  the  functional  brain  diseases  and  define  as  func- 
tional simply  those  diseases  which  can  be  cured  by 
such  means,  we  move,  of  course,  in  the  most  obvious 
circle  and  yet  just  that  is  the  too  frequent  fate  of  the 
discussions  in  certain  quarters. 

Every  psychical  disturbance  is  organic  inasmuch 
as  it  is  based  on  a  molecular  change  which  deranges 
the  function.  Some  of  these  changes  are  beyond 
restitution ;  some  can  be  brought  back  to  a  well-work- 
ing structure  by  strictly  physical  agencies  like  drugs 
or  electricity;  others  can  be  repaired  by  physiological 
stimuli  which  reach  directly  the  higher  brain  cells 
through  the  sense  organs  and  which  we  call  psychical 
under  one  aspect,  but  which  certainly  remain  physio- 
logical influences  from  another  aspect.  And  these 
psychophysiological  influences  of  the  spoken  words 
or  similar  agencies  are  thus  indeed  for  therapeutic 
effect  entirely  coordinated  with  the  douche  and  the 


84  PSYCHOTHERAPY 

bath  and  the  electric  current  and  the  opiate.  It  is  a 
stimulation  of  certain  brain  cells,  an  inhibition  of 
certain  others:  a  subtle  apparatus  which  must  be 
handled  with  careful  calculation  of  its  microscopical 
causes  and  effects.  That  these  words  from  an  en- 
tirely different  point  of  view  may  mean  a  moral  ap- 
peal and  have  ethical  value,  point  to  moral  and  reli- 
gious ideas  and  reenforce  the  spiritual  personality,  lies 
entirely  outside  of  the  psychotherapeutic  calculation. 
As  long  as  the  curing  of  the  patient  is  the  aim,  the 
faith  in  God  is  not  more  valuable  than  the  faith  in 
the  physician  and  the  moral  appeal  of  no  higher 
order  than  the  influence  through  the  galvanic  current. 
They  come  in  question  only  as  means  to  an  end  and 
they  are  valuable  only  in  so  far  as  they  reach  the  end. 
That  they  can  be  related  to  an  entirely  different 
series  of  purposes,  to  the  system  of  our  moral  ideas, 
ought  not  to  withdraw  the  attention  of  the  psycho- 
therapist from  his  only  aim,  to  cure  the  patient. 
The  highest  moral  appeal  may  be  even  a  most  unfit 
method  of  treatment  and  the  religious  emotion  may 
just  as  well  do  harm  as  good  from  the  point  of  view 
of  the  physician.  Psychotherapy  has  suffered  too 
much  from  the  usual  confusion  of  standpoints. 


SUGGESTION  AND  HYPNOTISM 

PSYCHOTHERAPY  has  now  become  for  us 
the  effort  to  repair  the  disturbed  equilibrium 
of  human  functions  by  influencing  the  mental 
life.  It  is  acknowledged  on  all  sides  that  the 
most  powerful  of  these  influences  is  that  of 
suggestion.  This  is  an  influence  which  is  most 
easily  misunderstood  and  which  has  most  often 
become  the  starting  point  for  misleading  theories. 
Before  we  enter  into  the  study  of  the  practical 
effects  of  suggestion  and  the  psychotherapeutic 
results,  we  must  examine  this  tool  in  the  hand  of 
the  psychotherapist  from  a  purely  psychological 
viewpoint.  The  patient  may  perhaps  sometimes 
profit  from  suggestion  the  more,  the  less  he  under- 
stands about  its  nature,  but  the  physician  will  always 
secure  the  better  results,  the  more  clearly  he  appre- 
hends the  working  of  this  subtle  tool.  Of  course, 
that  does  not  mean  that  any  psychology  is  able  to 
explain  the  process  of  suggestion  to  a  point  where  all 
difficulties  are  removed,  but  at  least  the  mysteries  can 
be  removed  and  the  effects  can  be  linked  with  other 
well-known  processes. 

Let  us  be  clear  from  the  start  that  suggestion  is 

85 


86  PSYCHOTHERAPY 

certainly  nothing  abnormal  and  exceptional,  nothing 
which  leads  us  away  from  our  ordinary  life,  nothing 
which  brings  us  nearer  to  the  great  riddles  of  the 
universe.  There  is  no  human  life  into  which  sug- 
gestion does  not  enter  in  a  hundred  forms.  Family 
life  and  education,  law  and  business,  public  life  and 
politics,  art  and  religion  are  carried  by  suggestion. 
A  suggestion  is,  we  might  say  at  first,  an  idea  which 
has  a  power  in  our  mind  to  suppress  the  opposite 
idea.  A  suggestion  is  an  idea  which  in  itself  is  not 
different  from  other  ideas,  but  the  way  in  which  it 
takes  possession  of  the  mind  reduces  the  chances  of 
any  opposite  ideas ;  it  inhibits  them.  It  is  indeed  the 
best  result  of  any  successful  education,  that  the  teach- 
ings have  taken  hold  of  the  mind  of  the  young  in 
such  a  way  that  all  the  opposite  tendencies  and  im- 
pulses and  wishes  do  not  come  to  development.  The 
well-educated  person  does  not  need  to  participate  in 
a  struggle  between  good  and  bad  motives,  for  that 
which  has  been  impressed  upon  his  mind  does  not 
allow  the  other  side  to  come  up  at  all.  Our  life 
would  be  crowded  with  inner  conflicts  if  education 
had  not  secured  for  us  from  the  start  preponderance 
for  the  suggestions  of  our  educators. 

The  love  of  family  and  friends,  of  our  country  and 
our  party  are  in  the  same  way  such  suggestions.  We 
may  hear  arguments  for  the  other  side,  arguments 
which  easily  convince  the  man  of  the  other  party,  but 
they  do  not  appeal  to  us :  they  are  emasculated  before 
they  enter  our  minds;  they  have  no  chance  to  over- 
come the  resistance  because  suggestions  stand  in  their 


SUGGESTION  AND  HYPNOTISM      87 

way.  No  argument  will  overwhelm  the  suggestion 
which  religion  has  settled  in  our  inner  life,  and  from 
this  strongest  suggestion  which  can  stand  against  any 
temptation  of  life  small  psychological  steps  lead 
down  to  the  little  bits  of  suggestion  with  which  our 
daily  chance  life  is  over-flooded.  Every  advertise- 
ment in  the  newspaper,  every  display  in  the  shop- 
window,  every  warm  intonation  in  the  voice  of  our 
neighbor  has  its  suggestive  power,  that  is,  it  brings 
its  content  in  such  a  way  to  our  minds  that  the  desire 
to  do  the  opposite  is  weakened.  We  do  buy  the  ob- 
ject that  we  do  not  need,  and  we  do  follow  the  advice 
which  we  ought  to  have  reconsidered.  And  what 
would  remain  of  art  if  it  had  not  this  power  of  sug- 
gestion by  which  it  comes  to  us  and  wins  the  victory 
over  every  opposing  idea?  We  believe  the  painter 
and  we  believe  the  novelist,  if  their  technique  is  good. 
We  do  not  remember  that  the  inventions  of  their 
genius  are  contrary  to  our  life  experience;  we  feel 
sympathy  with  the  hero  and  do  not  care  in  the  least 
that  he  has  no  real  life.  The  suggestion  of  art  has 
inhibited  in  us  every  contrary  idea. 

Such  daily  experience  shows  us  that  suggestive 
power  may  belong  to  different  men  in  different  de- 
gree. There  are  lawyers  whose  arguments  and 
whose  presentation  open  our  mind,  it  seems,  to  any 
suggestion:  while  others  leave  us  indifferent;  we 
understand  their  idea,  we  follow  their  thoughts,  and 
yet  we  remain  accessible  to  opposite  influences. 
There  are  teachers  whose  authority  gives  to  every 
word  such  an  impressiveness  and  dignity  that  every 


88  PSYCHOTHERAPY 

opposite  thought  disappears,  while  others  throw  out 
words  which  are  forgotten.  On  the  other  hand,  the 
readiness  to  accept  suggestions  is  evidently  also  quite 
different  with  different  individuals.  From  the  most 
credulous  to  the  stubborn,  we  have  every  degree  of 
suggestibility,  the  one  impressed  by  the  suggestive 
power  of  any  idea  which  is  brought  to  his  mind,  the 
other  always  inclined  to  distrust  and  to  look  over  to 
the  opposite  argument.  Such  a  stubborn  mind  is 
indeed  not  only  without  inclination  for  suggestions, 
but  it  may  develop  even  a  negative  suggestibility; 
whatever  it  receives  awakens  an  instinctive  impulse 
towards  the  opposite.  Moreover  we  are  all  in  dif- 
ferent degrees  suggestible  at  different  times  and 
under  various  conditions.  Emotions  reenforce  our 
readiness  to  accept  suggestions.  Hope  and  fear, 
love  and  jealousy  give  to  the  impression  and  the  idea 
a  power  to  overwhelm  the  opposite  idea,  which  other- 
wise might  have  influenced  our  deliberation.  Fatigue 
and  intoxicants  increase  suggestibility  very  strongly. 
To  look  out  on  a  wider  perspective,  we  may  add  at 
once  that  an  artificial  increase  of  suggestibility  is  all 
which  constitutes  the  state  of  hypnotism. 

At  first,  however,  we  want  to  understand  the  ordi- 
nary process  of  suggestion  in  that  normal  form  in 
which  it  enters  into  every  hour  of  our  life  and  into 
every  relation  of  our  social  intercourse.  But  if  we 
begin  to  examine  the  structure  of  the  process,  we 
can  no  longer  be  satisfied  with  the  vague  reference  to 
ideas  and  their  opposites.  What  does  it  mean  after 
all  if  we  speak  of  opposite  ideas?  Can  we  not  en- 


SUGGESTION  AND  HYPNOTISM      89 

tertain  any  ideas  peacefully  together  in  our  conscious- 
ness? From  a  logical  standpoint,  ideas  may  contra- 
dict each  other,  but  that  refers  to  their  meaning. 
As  mere  bits  of  psychological  experience,  I  may  have 
any  ideas  together  in  my  consciousness.  I  can  think 
summer  and  winter  or  day  and  night  or  right  and 
left  or  black  and  white  or  love  and  hate  in  one  em- 
bracing thought.  As  mere  mental  stuff,  the  one  idea 
does  not  interfere  with  the  other.  On  the  other 
hand,  this  is  evident:  I  cannot  will  to  turn  to  the 
right  and  to  turn  to  the  left  at  the  same  time.  There 
may  be  a  wrangling  between  those  two  impulses,  but 
as  soon  as  my  will  stands  for  the  one,  the  other  is 
really  excluded.  Any  action  which  I  am  starting  to 
do  thus  crowds  out  the  impulse  to  the  opposed  action. 
In  the  sphere  of  psychological  facts,  we  have  here 
indeed  the  only  relation  between  two  happenings 
which  necessarily  involves  an  opposition.  We  could 
never  understand  why  one  brain  cell  might  not  work 
together  with  any  other  brain  cell,  but  we  do  under- 
stand that  nature  must  provide  for  an  apparatus  by 
which  the  impulse  to  one  action  makes  the  impulse  to 
the  opposite  action  ineffective.  There  is  no  action 
which  has  not  its  definite  opposite.  The  carrying 
out  of  any  impulse  involves  the  suppression  of  the 
contrary  impulse,  and  the  impulse  not  to  do  an  action 
involves  the  suppression  of  the  impulse  to  do  it. 
When  we  spoke  of  the  relations  of  mind  and  brain, 
we  mentioned  that  such  a  corelation  of  mental 
centers  indeed  exists.  Physiological  experiments 
have  demonstrated  that  the  activity  of  those  centers 


90  PSYCHOTHERAPY 

which  stimulate  a  certain  action  reduce  the  ex- 
citability of  those  brain  parts  which  awaken  the 
antagonistic  action.  As  far  as  the  world  of  actions 
is  concerned,  the  mechanism  of  the  process  of  sug- 
gestion thus  seems  not  inaccessible  to  a  physiological 
understanding. 

Various  ideas  of  movements  to  be  carried  out  are 
struggling  for  control  in  the  cortex  of  the  brain. 
That  is  the  normal  status  which  precedes  any  de- 
cision. The  channels  of  motor  discharge  are  open 
for  both  possibilities ;  we  may  turn  to  the  right  or  to 
the  left.  Then  the  play  of  associations  begins.  A 
larger  and  larger  circle  of  ideas  surrounds  the  idea 
of  the  one  and  of  the  other  goal.  Those  ideas 
awaken  emotions.  On  the  one  side  may  call  our 
duty  and  on  the  other  side  our  pleasure.  Larger 
and  larger  parts  of  the  central  content  of  our  con- 
sciousness, of  our  own  personality,  become  involved; 
our  principles  and  maxims,  our  memories,  our  hopes 
and  fears,  enter  into  the  battle  until  deeper  strata  of 
the  idea  of  ourselves  enter  into  a  firm  association  with 
the  one  side,  reenforcing,  perhaps,  the  idea  of  the 
goal  at  the  right.  This  opens  wide  the  channels  of 
discharge  for  the  movement  to  the  right  and  inhibits 
thereby  the  excitability  of  the  center  which  leads  to 
the  opposite  action.  The  channel  of  discharge  to 
the  movement  towards  the  left  becomes  closed,  the 
idea  of  that  movement  fades  away  and  becomes  in- 
hibited: we  are  moving  towards  the  right.  The  out- 
come was  the  product  of  our  total  personality. 

But  this  result  would  have  been  different,  if  from 


SUGGESTION  AND  HYPNOTISM      91 

the  start  the  channels  of  discharge  had  not  been 
equally  open  for  both  possible  movements,  and  if 
thus  the  relative  resistance  to  the  impulse  had  not 
been  equal  on  both  sides.  If,  for  instance,  we  had 
gone  from  the  given  point  frequently  to  the  left,  as  a 
result  of  the  habit  and  training,  the  impulse  to  the 
left  would  have  found  less  nervous  resistance.  The 
channels  would  have  become  widened  by  the  repeti- 
tion and  the  opposite  channels  would  have  been  some- 
what closed  by  the  lack  of  use.  Or  if  instead  of  such 
previous  habit,  we  should  see  at  the  decisive  moment 
others  turning  to  the  left,  the  impression  would  have 
become  the  starting  point  for  a  reaction  of  mere  in- 
stinctive imitation.  While  we  might  not  have  fol- 
lowed that  imitative  impulse  at  once,  yet  the  channels 
would  have  been  widened,  the  discharge  in  the  di- 
rection would  have  been  prepared  by  it,  the  resistance 
would  have  been  lowered  and  the  chances  for  the 
opposite  movement  would  have  been  decreased. 
Those  people  who  moved  to  the  left  gave  us  by  their 
action  the  same  kind  of  an  impulse  which  they  would 
have  furnished  if  they  had  begged  us  with  words,  or 
if  they  had  ordered  us  to  follow  them  with  authori- 
tative firmness.  In  each  of  these  cases,  the  influence 
would  have  amounted  to  a  suggestion.  Whether  we 
watched  the  movements  of  other  people  or  whether 
their  words  made  an  impression  on  us,  in  either  case 
the  way  became  prepared  for  a  certain  line  of  action 
and  therefore  the  way  for  the  opposite  action  became 
blocked.  The  final  outcome  was  thus  no  longer  an 
entirely  free  play  of  motor  ideas,  but  there  was  a  little 


92  PSYCHOTHERAPY 

inequality  in  play.  The  one  had  from  the  start  a 
better  chance,  the  other  was  from  the  start  laboring 
under  difficulties.  The  suggestion  of  actions  is  thus 
nothing  but  making  use  of  the  antagonistic  character 
in  the  nervous  paths  which  start  from  the  motor 
centers.  That  all  such  phrases  as  the  opening  and  the 
closing,  the  widening  and  blocking,  of  channels  of 
discharge  are  only  metaphors  hardly  needs  special 
emphasis.  Instead  of  such  comparisons,  we  ought 
rather  to  think  of  chemical  processes  which  offer 
various  degrees  of  resistance  to  the  propagation  of 
the  nervous  excitement. 

We  see  from  here  the  direction  in  which  many  psy- 
chotherapeutic  efforts  must  lie.  efforts  which  are  en- 
tirely within  the  limits  of  the  daily  normal  experience 
and  belong  to  the  medical  practice  of  every  physician, 
yes,  to  the  helpful  influence  of  every  man  in  practical 
life.  The  intemperate  man  may  suffer  from  his  in- 
ability to  resist  his  desire  for  whiskey.  The  idea  of 
his  visit  to  the  saloon  finds  the  channels  of  discharge 
open.  We  argue  with  him,  we  tempt  him  by  at- 
tractions which  lead  to  other  ways,  we  suggest  to 
him  that  he  spend  those  evening  hours  perhaps  with 
friends  or  with  books  for  which  we  awaken  his  in- 
terest; we  do  it  as  impressively  as  we  can,  we  appeal 
to  his  friendly  feeling  for  us;  and  if  again  the  hour 
comes  in  which  the  desire  for  the  artificial  stimulation 
sets  in  with  a  motor  impulse  towards  the  bottle,  the 
channels  for  discharge  have  now  been  blocked.  The 
idea  of  the  opposite  action  arises,  it  associates  itself 
with  the  emotions  which  we  stirred  up  in  his  mind, 


SUGGESTION  AND  HYPNOTISM      93 

it  associates  itself  with  the  respect  for  the  adviser, 
and  thus  new  clusters  of  thought  reenforce  that  idea 
of  action  which  we  suggested,  and  this  opposite  line 
of  action  now  finds  a  minimum  resistance  because  our 
appeal  has  opened  beforehand  the  gate.  The  desire 
for  the  book  works  itself  out  into  action  while  the 
desire  for  the  cup  finds  increased  resistance. 

Just  this  is  the  kind  of  suggestion  with  which  we 
correct  faulty  action  everywhere  in  our  social  circle; 
and  yet  small  steps  lead  on  from  here  to  the  case 
where  perhaps  the  desire  for  alcohol  has  reached  that 
pathological  intensity  in  which  the  equilibrium  is  en- 
tirely disturbed  and  cannot  be  repaired  without  sug- 
gestions of  a  much  more  powerful  character,  given  in 
a  state  of  artificially  increased  suggestibility — in 
hypnotism.  The  principle  of  opening  certain  chan- 
nels of  discharge  for  the  purpose  of  closing  the  op- 
posite channels  remains  in  the  extreme  case  the  same 
as  in  the  more  ordinary  cases.  The  impulse  to  drink 
is  a  positive  one,  but  the  principle  is  not  different 
where  the  impulse  is  negative.  A  friend  who  comes 
from  the  quiet  country  may  feel  unable  to  pass  the 
busy  square  of  the  city.  The  fear  of  an  accident 
holds  back  his  steps,  he  cannot  give  the  impulse  to 
walk  through  the  crowded  rush  of  vehicles.  Now 
either  by  words  of  advice,  by  persuasion  or  by  show- 
ing the  way,  we  may  apply  our  suggestion,  we  open 
the  channels  of  discharge  for  the  necessary  move- 
ments and  thus  decrease  the  excitability  of  those 
centers  in  which  nervous  fear  was  playing.  And 
again  small  steps  lead  from  here  to  the  case  of  the 


94  PSYCHOTHERAPY 

psychasthenic  sufferer  whose  phobia  does  not  allow 
him  to  cross  any  square  and  where  reenforced  sug- 
gestion has  to  break  open  the  ways  for  the  walking 
movement  when  the  square  is  reached. 

Thus  we  are  not  far  from  a  causal  understanding 
of  suggestive  influences  wherever  actions  are  con- 
cerned, where  movements  are  to  be  reenforced  or  to 
be  suppressed  and  where  antagonism  of  the  motor 
paths  is  involved.  But  that  does  not  seem  to  lead 
us  nearer  to  the  much  larger  group  of  states  in  which 
the  whole  suggestive  process  concerns  apparently  the 
interplay  of  ideas  alone,  where  not  actions  but  im- 
pressions are  controlled  by  suggestion,  where  not  im- 
pulses but  thoughts  are  strengthened  or  inhibited. 
Here  lies  the  real  psychophysical  problem  which  has 
been  by  far  too  much  neglected  in  scientific  psychol- 
ogy and  has  almost  been  hidden  and  made  to  disappear 
in  the  wonderful  accounts  of  the  hypnotists.  But  all 
those  mysterious  stories  as  to  the  achievements  of  sug- 
gestion cannot  help  so  long  as  we  do  not  understand 
the  working  of  the  process,  and  we  shall  have  the 
better  chance  to  understand  it  the  more  we  keep 
away  from  the  uncanny  and  mysterious  results  which 
refer  to  the  most  complex  conditions,  and  rather 
seek  to  analyze  the  state  in  its  simplest  forms  and 
compare  it  with  other  simple  mental  processes.  The 
psychology  of  suggestion  has  suffered  too  much  by 
the  fascination  which  its  most  complex  forms  exert  on 
a  trivial  curiosity. 

Yet  the  problem  of  suggestion  in  the  field  of  ideas 
stands  after  all  not  isolated.  Instead  of  connecting 


SUGGESTION  AND  HYPNOTISM     95 

it  with  the  weird  reports  of  mystic  influence  from 
man  to  man,  let  us  rather  link  it  with  the  simple  ex- 
perience of  attention.  There  is  no  pulse-beat  of  our 
life  in  which  attention  does  not  play  its  little  role. 
But  does  not  attention  share  with  suggestion  the 
characteristic  feature  that  some  contents  of  conscious- 
ness are  reenforced  and  others  are  suppressed?  This 
negative,  this  suppressing  character  of  attention  is 
not  a  chance  by-product,  it  is  most  essential.  There 
is  no  attention  without  it.  If  I  am  studying,  I  do 
not  hear  the  conversation  around  me,  and  if  I  listen 
to  the  conversation,  my  studies  in  hand  become  in- 
hibited. If  I  enjoy  the  play  on  the  stage  and  give 
to  it  my  full  attention,  my  memories  of  the  day's 
work  are  suppressed;  if  I  think  of  the  happenings  of 
the  day,  I  am  not  attentive  to  the  play  and  hardly 
notice  what  is  going  on.  The  inhibited  impression 
may  often  disappear  entirely.  While  I  am  reading 
I  am  not  at  all  aware  of  the  tactual  and  muscular 
sensations  in  my  legs,  and  if  I  am  completely  absorbed 
by  my  book,  I  may  not  even  notice  that  the  bell 
rings.  In  short,  we  have  here  as  the  most  character- 
istic relation,  just  as  in  suggestion,  the  fact  that  one 
mental  state  becomes  vivid,  and  that  others  are  losing 
ground,  become  less  vivid,  are  inhibited  and  perhaps 
disappear  entirely.  '  0 

Of  course,  to  point  to  the  similarity  between  sug-  Ax 

gestion  and  attention  is  not  a  real  explanation.     It          >  £  / 
may  be  answered  that  attention  simply  offers  the  same    *wA     / 
difficulties  once  more.     How  can  we  explain  in  the     \  / 
attention   process  the   fact  that  one  idea,   the  one 


96  PSYCHOTHERAPY 

attended  to,  becomes  vivid  and  that  others  evaporate? 
The  difficulty  evidently  cannot  be  removed  by  simply 
saying  that  only  one  sensorial  process  can  be  de- 
veloped in  the  brain  at  one  time.  The  popular  de- 
scriptions of  attention  easily  make  it  appear  as  if 
such  were  the  solution  of  the  problem.  If  one 
sensorial  brain  part  is  intensely  engaged,  the  re- 
mainder of  the  brain  is  condemned  to  a  kind  of  in- 
activity. Yet  such  a  dogma  is  hardly  better  than  the 
old-fashioned  one  that  the  soul  can  have  only  one 
idea  at  a  time.  We  know  too  well  now  that  the  psy- 
chophysical  system  is  an  extremely  complex  equilib- 
rium of  millions  of  elements.  Thus  every  change 
must  be  explained  with  reference  to  this  complex 
manifold.  Above  all,  the  facts  simply  contradict 
such  an  over-simple  explanation,  inasmuch  as  it  is  not 
at  all  true  that  only  one  content  of  consciousness  can 
become  vivid.  Our  attention  does  not  focus  upon 
one  point  at  all  but  may  illuminate  a  large  field  and 
thus  give  vividness  to  various  complex  groups.  If  I 
am  thinking  about  a  scientific  problem,  an  abundance 
of  reminiscences  of  previous  reading  and  imaginative 
ideas  of  possible  solutions,  associative  thoughts  and 
conclusions  are  with  equal  vividness  before  my  mind 
and  the  forthcoming  thought  may  be  influenced  by 
this  total  combination.  I  have  no  right  whatever  to 
say  that  the  idea  of  a  certain  solution  excludes  there 
in  my  mind  the  consideration  of  the  books  which  I 
have  read  and  of  the  discussions  which  I  have  heard. 
Emotions  may  be  superadded.  In  short,  a  world  of 
mental  states  may  be  held  together  by  one  act  of  at- 


SUGGESTION  AND  HYPNOTISM      97 

tention.  And  new  and  ever  new  thoughts  are  shoot- 
ing in,  and  all  still  find  place  there  in  the  field  at- 
tended to,  while  on  the  other  hand  my  slight  head- 
ache is  inhibited  and  an  appointment  is  forgotten. 
At  a  gay  banquet,  my  attention  may  be  given  to  the 
whole  hall  with  all  its  color  effects  and  its  flowers, 
and  to  all  that  the  table  offers  and  to  the  music  from 
the  orchestra  and  to  the  jokes  of  my  neighbors.  It 
is  not  true  that  arty  one  of  those  parts  suppresses  the 
vividness  of  the  others,  they  seem  rather  to  maintain 
and  to  help  one  another ;  and  yet  in  the  next  moment, 
my  neighbor  may  bring  me  news  which  absorbs  my 
mind  entirely  and  leaves  no  room  for  the  flowers  and 
the  music  and  the  meal.  How  far  can  psychology 
do  justice  to  these  characteristics  of  attention? 

There  seems  to  be  but  one  way.  The  attended-to 
idea  does  not  exclude  every  other  idea,  but  it  does  ex- 
clude the  opposite  idea,  and  opposite  to  each  other  is 
here  again  that  pair  of  ideas  which  lead  to  opposite 
actions,  to  opposite  psychophysical  attitudes.  We 
must  remember  here  the  psychomotor  character  of 
our  brain  processes  which  we  so  fully  discussed.  We 
recognized  the  fundamental  truth  that  there  is  no 
sensorial  state  which  is  not  at  the  same  time  the  start- 
ing-point for  motor  reaction.  We  recognized  that 
the  brain  is  by  its  whole  psychological  development 
a  great  switchboard  which  transfers  incoming  cur- 
rents into  outgoing  ones  and  that  its  biological  mean- 
ing lies  in  the  fact  that  it  is  the  center  piece  of  an  arc 
which  leads  from  the  sense  organs  to  the  muscles. 
We  cannot  conceive  of  those  relations  as  complex 


98  PSYCHOTHERAPY 

enough;  we  know,  of  course,  that  millions  of  nerve 
fibers  lead  from  the  periphery  to  the  highest  psycho- 
physical  apparatus  in  the  cortex  of  the  brain  and  that 
millions  of  fibers  bring  about  the  interrelation  be- 
tween these  central  stations,  but  we  must  never  forget 
that  millions  of  fibers  also  represent  the  outgoing 
paths  and  that  they  too  lead  down  to  lower  central 
motor  instruments  which  are  again  in  numberless  co- 
relations.  Any  impression  is  thus  a  starting  point  for 
attitudes  and  reactions  and  it  is  an  empty  abstraction 
to  consider  it  otherwise.  An  idea  is  never,  psycho- 
physically  considered,  the  end  of  the  process,  it  is 
always  also  a  beginning.  No  external  action  may 
follow,  but  the  mental  impulse  to  such  is  nevertheless 
starting  in  the  highest  center. 

If  we  look  at  the  landscape,  every  single  spot  of 
color,  reaching  a  nerve  fiber  in  our  eye  and  finally  a 
sensory  cell  in  our  brain,  is  there  the  starting  point 
for  an  impulse  to  make  an  eye  movement  in  the  di- 
rection of  the  seen  point.  The  eye  may  remain  en- 
tirely quiet  as  the  impulse  to  move  to  the  right  and 
to  the  left,  to  move  up  and  to  move  down,  may  be 
equally  strong,  but  those  thousands  of  impulses  work 
in  the  motor  paths  and  only  their  equilibrium  results 
in  the  suppression  of  the  outer  movement.  With 
such  motor  scheme,  we  begin  to  understand  the 
selective  process  in  attention.  An  impression  may  be 
accompanied  by  other  stimuli  and  associations,  by 
thoughts  and  ideas,  and  thousands  of  sensory  excite- 
ments may  thus  arise  in  the  cortex,  but  only  those  have 
a  chance  for  full  vividness  of  development  which  co- 


99 

operate  in  the  motor  action  already  started.  Those 
impressions  which  would  lead  to  the  opposite  actions 
have  no  chance  because  their  motor  paths  are  blocked 
and  their  own  full  development  is  dependent  upon 
their  possibility  of  expression.  To  close  the  path 
means  to  inhibit  the  idea  which  demands  such  action. 
We  can  attend  to  a  hundred  thoughts  together,  if  they 
all  lead  to  the  same  attitude  and  deed.  We  can  look 
at  the  opera,  can  see  every  singer  and  every  singer's 
gown,  can  listen  to  every  word,  can  have  the  whole 
plot  in  mind,  can  hear  the  thousands  of  tones  which 
come  from  the  orchestra ;  and  yet  combine  all  that  in 
one  act  of  attention,  because  it  all  belongs  to  the  same 
setting  of  our  reactive  apparatus.  Whatever  the 
one  wants  is  wanted  by  the  others.  But  if  at  the 
same  time  our  neighbor  speaks  to  us,  we  do  not  notice 
it;  his  words  work  as  a  stimulus  which  demands  an 
entirely  different  motor  setting  as  answer.  There- 
fore the  words  remain  unvivid  and  unnoticed. 

To  attend  means  therefore  to  bring  about  a  motor 
setting  by  which  the  object  of  attention  finds  open 
channels  for  discharge  in  action.  Which  particular 
action  is  needed  in  the  state  of  attention  cannot  be 
doubtful.  Attention  demands  those  motor  responses 
and  those  inner  steps  by  which  the  object  of  attention 
shows  itself  more  fully  and  more  clearly.  When  we 
give  attention  to  the  picture  we  want  to  see  more  de- 
tails, when  we  give  attention  to  the  problem  we  want 
to  recognize  more  of  the  factors  involved,  when  we 
give  attention  to  the  banquet  we  want  to  grasp  more 
of  the  pleasurable  features.  This  aim  of  attention 


ioo  PSYCHOTHERAPY 

involves  that,  as  part  of  such  reactions,  the  sense 
organs  become  adjusted;  we  fixate  the  eyeball,  we 
listen,  and  in  consequence  the  object  itself  becomes 
clearer,  and  through  the  easy  passage  into  the  motor 
channels  the  whole  impression  becomes  vivid.  At 
the  same  time,  all  those  associations  must  be  ree'n- 
forced  and  become  vivid  too  which  lead  to  the  same 
action.  On  the  other  hand,  the  opening  of  the  one 
passageway  closes  the  path  to  the  opposite  action  and 
inhibits  the  impressions  which  would  interfere  with 
our  interest.  Every  act  of  attention  becomes,  there- 
fore, a  complex  distribution  in  the  reinforcement  and 
inhibition  of  mental  states. 

Now  let  us  come  back  to  suggestion.  It  shares,  we 
said,  with  attention,  the  power  to  reenforce  and  to 
inhibit.  But  if  we  examine  what  is  involved  in  the 
suggestion  of  an  idea,  we  find  surely  more  than  a 
mere  turning  of  the  attention  towards  one  idea  and 
turning  the  attention  away  from  another  idea.  That 
which  characterizes  and  constitutes  suggestion  is  a 
belief  in  the  idea,  an  acceptance  of  the  idea  as  real 
and  the  dismissal  of  the  opposite  idea  as  unreal. 
Yes,  we  may  say  directly  that  it  is  meaningless  to 
speak  of  suggesting  an  idea;  we  suggest  either  an 
action  or,  if  no  action  is  concerned,  we  suggest  belief 
in  an  idea.  If  I  suggest  to  the  fearful  man  at  twi- 
light that  the  willow-tree  trunk  by  the  wayside  is  a 
man  with  a  gun,  I  do  not  turn  his  attention  to  an 
abstract  idea  of  a  robber  nor  do  I  simply  awaken 
the  visual  impression  of  one,  but  I  make  him  believe 
that  such  an  idea  is  there  realized,  that  he  really  sees 


SUGGESTION  AND  HYPNOTISM     101 

the  person.  If  I  suggest  to  him  that  he  hears  distant 
bells  ringing  or  that  he  feels  a  slight  headache,  he 
may  not  be  suggestible  enough  to  accept  it,  but  if  he 
accepts  it  he  is  not  simply  attending  to  the  idea  which 
I  propose  but  he  is  convinced  of  its  real  existence. 
The  same  holds  true  with  the  negative;  if  I  suggest 
to  him  that  the  slight  headache  of  which  he  com- 
plained has  disappeared  or  that  the  smell  which  he 
noticed  has  stopped,  I  do  not  simply  invite  him  to 
think  of  the  absence  of  such  sensations.  It  becomes 
for  him  a  suggestion  only  if  he  becomes  convinced 
that  these  disturbances  have  now  become  unreal. 
The  same  holds  true  for  all  those  suggestions  of  ideas 
which  belong  to  our  practical  life,  the  suggestions 
which  art  imprints  on  our  minds,  or  which  politics 
and  religion  impart.  As  long  as  we  are  under  the 
suggestion  of  the  novelist,  we  really  believe  in  the 
existence  of  the  heroine;  we  really  believe  in  the 
validity  of  the  political  party  principle;  it  is  not  an 
argument  to  which  we  simply  give  our  attention,  it 
becomes  a  suggestion  only  when  the  belief  in  its  ob- 
jective existence  controls  our  minds.  We  may  say  in 
general  that  suggestions  which  are  not  suggestions  of 
actions  are  without  exception  suggestions  of  belief. 
Actions  and  beliefs  are  the  only  possible  material  of 
any  suggestion. 

Yet  what  else  is  a  belief  than  a  preparation  for 
action?  I  may  think  of  an  object  without  preparing 
myself  for  any  particular  line  of  behavior.  Here  in 
the  room  I  may  think  of  rain  or  sunshine  on  the 
street  as  a  mere  idea,  but  to  know  that  it  now  really 


102  PSYCHOTHERAPY 

rains  or  shines  means  something  entirely  different. 
It  means  a  completely  new  setting  in  my  present  atti- 
tude, a  setting  by  which  I  am  prepared  to  act  along 
the  one  or  the  other  line,  to  take  an  umbrella  or  to 
take  a  straw  hat,  when  I  am  to  leave  the  house.  I 
may  think  of  the  door  of  this  room  as  locked  or  un- 
locked without  transcending  the  mere  sphere  of 
imagination,  but  to  believe  that  it  is  the  one  or  the 
other  means  a  new  setting  in  my  motor  adjustments.  If 
it  is  locked  I  know  that  I  cannot  leave  the  room  with- 
out a  key.  Every  belief  means  the  preparation  for  a 
definite  line  of  action  and  a  new  motor  adjustment  in 
the  whole  system  of  motor  paths,  an  adjustment  by 
which  my  actions  in  future  will  be  switched  off  at  once 
into  particular  paths.  And  there  is  theoretically  no 
difference  whether  my  belief  refers  to  the  proposition 
that  the  door  is  locked  or  that  a  God  exists  in  Heaven. 
But  if  every  belief  is  such  a  new  motor  setting,  then 
we  are  evidently  brought  back  to  the  mechanism 
which  was  essential  for  every  suggestion  of  action 
on  the  one  side  and  for  every  process  of  attention  on 
the  other  side,  namely,  the  mechanism  of  antagonistic 
movements.  To  prepare  ourselves  for  one  line  of 
action  means  to  close  beforehand  the  channels  of  dis- 
charge for  the  opposite.  The  suggestible  mind  sees 
the  man  with  a  gun  on  the  wayside  because  he  is 
preparing  himself  in  his  expectation  for  the  appro- 
priate action;  he  is  ready  for  the  fight  or  ready  to 
run  away,  and  every  line  of  the  tree  trunk  is  apper- 
ceived  with  reference  to  this  motor  setting.  The 
smell,  on  the  other  hand,  has  disappeared  under  the 


SUGGESTION  AND  HYPNOTISM    103 

influence  of  the  suggestion  because  a  new  motor  ad- 
justment has  set  in,  in  which  he  is  prepared  to  act  as 
if  there  were  no  smell. 

The  difference  between  suggestion  and  attention 
lies  thus  only  in  this :  the  motor  response  in  attention 
aims  towards  a  fuller  clearness  of  the  idea,  for  in- 
stance, by  fixating,  listening,  observing,  searching; 
while  the  motor  response  in  suggestion  aims  towards 
the  practical  action  in  which  the  object  of  the  idea  is 
accepted  as  real.  In  attention,  we  change  the  ob- 
ject in  making  it  clearer;  in  suggestion,  we  change 
ourselves  in  adapting  ourselves  to  the  new  situation 
in  which  we  believe.  If  you  consider  attention  as  a 
psychophysical  process  open  to  physiological  explana- 
tion, you  have  surely  no  reason  to  seek  anything  mys- 
terious in  the  process  of  suggestion ;  and  no  new  prin- 
ciple is  involved,  if  we  come  from  the  effect  of  the 
smallest  suggestive  hint  to  the  complex  and  power- 
ful suggestions  which  overwhelm  the  whole  personal- 
ity. 

The  two  great  types  of  suggestion,  the  suggestion  of 
actions  and  the  suggestion  of  ideas,  have  now  come 
nearer  together  since  we  have  seen  that  the  suggestion 
of  ideas  is  really  a  suggestion  of  the  practical  accept- 
ance of  ideas,  and  that  means,  of  a  preparation  to- 
wards a  certain  line  of  action.  In  the  one  case  I 
suggest  the  idea  of  a  certain  action  and  this  motor 
idea  leads  to  the  action  itself,  and  in  the  other  case  I 
suggest  a  certain  preparatory  setting  for  action  and 
that  will  lead  to  the  appropriate  action  whenever  the 
time  for  action  comes.  Every  suggestion  is  thus  ulti- 


104  PSYCHOTHERAPY 

mately  a  suggestion  of  activity.     The  most  effective 


suggestion  for  an  action  results,  of  course,  if  both 
methods  are  combined,  that  is,  if  we  suggest  not  only 
the  will  to  perform  the  action,  but  at  the  same  time 
the  belief  that  the  end  of  the  action  will  be  real. 
Suggestion  reaches  us  usually  from  without.  Yet 
there  is  again  no  new  principle  involved,  when  the 
new  motor  setting  results  from  one's  own  associations 
and  emotions.  Then  we  speak  of  auto-suggestion. 
It  is  the  same  difference  which  exists  between  the  at- 
tention called  forth  through  an  outer  impression  and 
the  attention  directed  by  our  own  will.  Loud  noise 
demands  our  attention,  and  even  a  whispered  word 
may  awaken  associations  which  stir  up  the  attention. 
In  both  cases  the  channels  for  adjustment  become 
opened  without  our  intention.  But  if  we  are  expect- 
ing something  of  importance,  if  we  start  to  watch  a 
certain  development  and  to  find  something  which  we 
seek,  we  open  the  channels  by  our  own  effort  before- 
hand and  produce  our  own  settings  thus  through  a 
voluntary  attention.  In  this  way  suggestion  too  may 
start  from  without, — by  a  spoken  word,  by  a  move- 
ment, by  a  hint;  or  may  start  within  us  and  may  give 
us  our  caprices  and  our  prejudices. 

We  must  not  neglect  one  other  feature  of  the  sug- 
gestion. Not  every  proposition  to  action  or  to  be- 
lief can  be  called  a  suggestion.  Essential  too  re- 
mains the  other  side  of  it,  the  overcoming  of  the 
resistance.  A  mere  request,  "  Please  hand  me  the 
book  on  the  table,"  or  a  mere  communication,  "  It 
rains,"  may  produce  and  will  produce  the  fit  motor 


SUGGESTION  AND  HYPNOTISM    105 

response,  the  movement  towards  handing  over  the 
book  or  opening  of  the.  umbrella,  and  yet  there  may 
be  no  suggestive  element  involved.  We  have  a  right 
to  speak  of  suggestion  only  if  a  resistance  is  to  be 
broken  down,  that  is,  if  the  antagonistic  impulse,  or 
the  motor  setting  for  the  antagonistic  action  is  rela- 
tively strong.  If  I  say  to  the  boy,  "  Hand  me  the 
book,"  when  he  was  anxious  to  hide  the  book  from 
my  eyes  and  thus  had  the  wish  not  to  hand  it  to  me 
and  the  tone  of  my  request  overwhelmed  his  own  in- 
tention, then  to  be  sure  suggestion  is  at  work.  The 
stronger  the  resistance,  the  greater  the  degree  of  sug- 
gestive power  which  is  needed  to  overcome  the  motor 
setting.  If  I  say  to  the  normal  man,  "  It  rains," 
while  he  sees  the  blue  sky  and  the  dry  street,  his  im- 
pression will  be  stronger  than  my  suggestion;  but  if  he 
is  suggestible  and  I  tell  him  that  it  will  rain,  he  may 
accept  it  and  take  an  umbrella  on  his  walk,  even  if  no 
indication  makes  a  change  of  weather  probable.  The 
present  impression  of  the  dry  street  was  strong 
enough  to  resist  the  suggestion,  the  imaginative  idea 
of  that  which  is  to  be  expected  in  the  next  hour  was 
too  weak,  and  was  overwhelmed  by  the  suggestion  of 
the  weather  prophecy. 

It  is  clear  that  the  whole  suggestive  effect,  being 
one  of  a  new  motor  setting,  depends  thus  entirely  on 
the  equilibrium  of  the  personality  which  receives  the 
suggestion.  Every  element  which  reaches  the  mind 
through  sense  organs  or  through  associations  must 
have  influence  in  helping  the  one  or  the  other  side, 
that  is,  in  opening  the  channels  of  action  in  the  sug- 


io6  PSYCHOTHERAPY 

gested  direction  or  in  the  antagonistic  one.  The 
results  appear  surprising  only  if  we  forget  how  end- 
lessly complex  this  psychomotor  apparatus  really  is. 
If  we  disregard  this  complexity  we  may  easily  have 
the  feeling  that  one  person  has  an  unexplainable  in- 
fluence over  another,  as  if  the  will  of  the  one  could 
control  in  a  mysterious  way  the  will  of  the  other. 
But  as  soon  as  we  see  that  every  action  is  the  result  of 
the  cooperation  of  hundreds  of  thousands  of  psycho- 
motor  impulses  which  are  in  definite  relation  to 
antagonistic  energies,  and  that  the  result  depends  up- 
on the  struggling  and  balancing  of  this  most  complex 
apparatus,  then  we  understand  more  easily  how  outer 
influences  may  help  the  one  or  the  other  side  to  pre- 
ponderance :  as  soon  as  the  balance  turns  to  the  one 
side,  a  completely  new  adjustment  must  set  in.  And 
we  understand  especially  that  there  is  nowhere  a  sharp 
demarcation  line  between  receiving  communications 
and  receiving  suggestions.  By  small  steps  suggestion 
shades  over  into  the  ordinary  exchange  of  ideas, 
propositions,  and  impressions,  just  as  attention  shades 
over  into  a  neutral  perception. 

To  be  suggestible  means  thus  to  be  provided  with 
a  psychophysical  apparatus  in  which  new  propositions 
for  actions  close  easily  the  channels  for  antagonistic 
activity.  Such  an  apparatus  carries  with  it  the  dis- 
advantage that  the  personality  may  too  easily  be 
guided  contrary  to  his  own  knowledge  and  experience. 
He  will  be  carried  away  by  every  new  proposition  and 
will  accept  beliefs  which  his  own  thoughts  ought  to 
reject.  On  the  other  hand,  it  has  the  advantage  that 


SUGGESTION  AND  HYPNOTISM    107 

he  will  be  open  to  new  ideas,  be  ready  to  follow  good 
examples,  never  stubbornly  close  his  mind  to  the  un- 
accustomed and  the  uncomfortable.  It  is  easy  to  de- 
termine the  degree  of  suggestibility.  Take  this  case. 
I  draw  on  the  blackboard  of  a  classroom  two  circles 
of  an  equal  size,  and  write  in  the  one  the  number 
fourteen  and  in  the  other  the  number  eighty-nine,  and 
ask  the  children  which  is  the  larger  circle.  The  sug- 
gestible ones  will  believe  that  the  circle  with  the 
higher  number  in  it  is  really  larger  than  the  other, 
the  unsuggestible  children  will  follow  the  advice  of 
their  senses  and  call  both  equal,  and  there  may  be  a 
few  children  with  negative  suggestibility  who  would 
call  the  circle  with  the  higher  number  the  smaller 
circle.  What  happened  to  the  suggestible  ones  was 
that  the  higher  number  brought  about  a  motor  atti- 
tude which  faced  that  whole  complex  as  being  more 
imposing  and  this  new  motor  setting  was  with  them 
strong  enough  to  overcome  the  motor  adjustment 
which  the  circles  alone  produced.  Such  experiments 
of  the  psychological  laboratory  can  be  varied  a  thou- 
sandfold, and  it  might  not  be  unwise  to  introduce 
them  into  many  practical  fields.  Everybody  knows 
for  instance  how  much  may  depend  upon  the  suggesti- 
bility of  the  witness  in  court.  The  suggestible  wit- 
ness believes  himself  to  have  seen  and  heard  what 
the  lawyer  suggests.  The  memory  picture  which 
such  a  witness  has  in  mind  offers,  of  course,  much  less 
resistance  to  the  opposite  action  and  attitude  and  be- 
lief than  the  immediate  impression.  If  I  show  the 
witness  a  colored  picture  of  a  room  and  close  the 


io8  PSYCHOTHERAPY 

book  and  ask  him  whether  there  were  three  or  four 
chairs  in  the  picture  and  whether  the  curtain  was 
green  or  red,  the  suggestible  man  will  decide  for  one 
or  the  other  proposition,  even  if  there  were  only  two 
chairs  and  a  blue  curtain.  The  perception  would 
have  resisted  the  suggestion,  the  fading  memory 
image  cannot  resist  it.  Thus  suggestibility  is  really 
a  practical  factor  in. every  walk  of  life.  And  it  is  in 
the  highest  interests  of  psychotherapy  that  this  inti- 
mate connection  between  suggestion  and  ordinary  talk 
and  intercourse,  between  suggestion  and  ordinary 
choice  of  motives,  between  suggestion  and  atten- 
tion be  steadily  kept  in  view  and  that  suggestion 
is  not  transformed  into  a  kind  of  mysterious 
agency. 

To  be  sure,  the  importance  of  suggestion  for  psy- 
chotherapy is  not  confined  to  these  suggestive  proc- 
esses of  daily  life.  They  play  a  role  there,  as  we 
shall  see,  and  we  shall  claim  that  even  the  mere  pres- 
ence of  the  physician  may  have  its  suggestive  power 
and  so  may  every  remedy  which  he  applies.  But  no 
doubt  many  of  his  suggestive  effects  depend  on  a 
power  which  far  transcends  the  suggestions  of  our 
daily  life.  Yet  the  psychologist  must  insist  again 
that  no  new  principle  is  involved,  that  even  in  the 
strongest  forms  of  suggestion,  in  hypnotism,  nothing 
depends  upon  any  special  influence  emanating  from 
the  mind  of  the  hypnotizer  or  upon  any  special  power 
flowing  over  from  brain  to  brain;  but  that  everything 
results  from  the  change  of  equilibrium  in  the  psycho- 
motor  processes  of  the  hypnotized,  and  thus  upon  the 


SUGGESTION  AND  HYPNOTISM     109 

interplay  of  his  own  mental  functions.  All  that  is 
needed  is  a  higher  degree  of  suggestibility  than  is 
found  in  the  normal  life.  In  a  more  suggestible 
mind  even  the  direct  sense  impressions  may  be  over- 
whelmed by  the  proposition  for  an  untrue  belief  and 
the  strongest  desires  may  yield  to  the  new  propositions 
of  action.  This  library  may  then  become  a  garden 
where  the  hypnotized  person  picks  flowers  from  the 
floor,  and  the  wise  man  stands  on  one  leg  and  repeats 
the  alphabet,  if  the  hypnotizer  asks  him  to  do  so. 
Let  us  consider  at  first  this  extreme  case.  By  a  few 
manipulations  I  have  brought  a  man  into  a  deep  hyp- 
notic state.  He  is  now  unable  to  resist  any  sug- 
gestion, either  suggestion  of  impulse  or  suggestion  of 
belief,  and  as  every  one  of  the  hypnotic  phenomena 
can  be  explained  in  this  way,  we  may  claim  that  the 
hypnotic  state  is  in  its  very  nature  a  state  of  reen- 
forced  suggestibility.  Whether  I  say,  "  You  will  not 
move  your  arm,"  or  whether  I  say,  "  You  cannot  move 
your  arm,"  awakening  in  the  one  case  the  impulse  to 
the  suppression  of  the  movement,  in  the  other  case 
the  belief  in  the  impossibility  of  the  movement,  in 
either  case  the  result  is  the  same;  the  arm  remains 
stiff  and  any  effort  of  his  to  move  it  is  inhibited.  I 
may  go  to  the  extreme  and  tell  him  that  our  friend  by 
my  side  has  left  the  room;  he  will  not  see  him,  he 
will  not  even  hear  a  word  which  the  friend  speaks. 
If  I  take  a  hat  in  my  hand  and  put  it  on  the  friend's 
head,  the  hat  appears  to  hang  in  the  air.  Every  im- 
pression of  sound  or  sight  or  touch  which  comes  from 
the  friend  is  entirely  inhibited.  The  direct  sense  im- 


no  PSYCHOTHERAPY 

pression  of  eye  and  ear  is  thus  completely  over- 
whelmed by  the  suggestion. 

What  has  happened?  Are  the  manipulations 
which  I  applied  sufficient  to  produce  the  changes  by 
their  physical  influence  ?  Certainly  not ;  they  are  of 
the  most  different  kinds  and  yet  all  may  have  the  same 
effect.  Perhaps  I  may  have  used  the  easy  method 
of  making  the  subject  stare  at  a  shining  button  held 
in  front  of  his  forehead.  Or  I  may  have  used  slight 
tactual  impressions,  while  he  was  lying  with  closed 
eyes,  or  I  may  have  produced  the  abnormal  state  by 
monotonous  noises  of  falling  waterdrops,  or  I  may 
have  simply  spoken  to  him  and  asked  him  to  think  of 
sleep  and  to  relax  and  to  feel  tired,  while  I  held  my 
hand  on  his  forehead  or  while  I  held  his  hand  in  mine. 
Or  I  may  have  relied  upon  mild  talking  without 
touching  him  at  all ;  and  yet  every  time  the  result  was 
reached  in  the  same  degree.  There  is  thus  certainly 
no  special  physical  energy  which  like  a  magnetic  force 
flows  over.  It  cannot  even  be  said  that  my  will  is  en- 
gaged. I  have  often  hypnotized  without  even  think- 
ing of  the  subject  before  me,  going  through  adjusted 
manipulations  while  my  thoughts  were  engaged  in 
something  else.  I  have  even  hypnotized  over  the 
telephone ;  and  a  written  note  may  be  substituted  with 
the  same  result.  I  write  to  the  patient  that  two  min- 
utes after  receiving  this  letter  by  mail,  he  will  fall 
into  hypnotic  sleep.  The  effect  sets  in;  and  yet  at 
that  time,  I  may  not  remember  sending  the  note  at  all. 

It  is  thus  entirely  evident  that  the  hypnotic  effect 
results  only  from  the  mental  conditions  of  the  subject. 


SUGGESTION  AND  HYPNOTISM     in 

Whatever  may  stimulate  his  mind  to  the  right  kind  of 
reaction  will  produce  the  desired  result.  The  in- 
creased suggestibility  thus  sets  in  by  his  own  imagina- 
tion which  may  be  stirred  up  by  slight  visual  or 
tactual  or  acoustic  stimuli  or  by  monotonous  words  or 
by  feelings  of  relaxation  and  especially  by  words 
which  encourage  sleep.  But  just  because  it  is  the 
play  of  his  own  imagination,  the  most  essential  factor 
certainly  is  the  will  and  expectation  of  the  subject. 
No  one  can  really  be  hypnotized  against  his  own  will. 
And  to  expect  strong  hypnotic  effect  from  a  certain 
hypnotist  is  often  in  itself  sufficient  to  produce  hyp- 
notic sleep.  Thus  there  is  no  special  personal  power 
necessary  to  produce  hypnotism.  Everybody  can 
hypnotize.  And  almost  with  the  same  sweeping 
statement  it  may  be  said  everybody  can  be  hypno- 
tized, provided  that  he  is  willing  to  enter  into  this 
play  of  imagination.  The  young  child  or  the  insane 
person  is  therefore  unfit. 

Of  course,  not  everybody  can  be  hypnotized  to  the 
same  degree.  Just  as  the  normal  suggestibility 
showed  itself  very  different  with  different  persons,  the 
degree  of  artificial  reinforcement  varies  still  more. 
Practically  everybody  can  be  brought  to  that  break- 
down of  the  resistance  in  which  he  can  no  longer  open 
the  eyes  against  the  order  of  the  hypnotist,  but  rather 
few  can  be  brought  to  the  point  of  seeing  extended 
hallucinations,  or  accepting  the  disappearance  of  per- 
sons who  are  speaking,  or  of  yielding  to  the  impulse 
to  a  dangerous  action.  The  highest  reported  degree, 
in  which  even  criminal  actions  are  performed  by 


ii2  PSYCHOTHERAPY 

honest  men,  exists  in  my  opinion  only  in  the  imagina- 
tion of  amateurs;  it  is  certainly  not  difficult  to  produce 
sham  crimes  for  performance'  sake,  with  paper  dag- 
gers and  toy  pistols,  but  that  is  no  proof  at  all  that 
the  hypnotized  person  would  commit  a  crime  under 
conditions  under  which  he  has  the  conviction  that  he 
faces  a  real  criminal  situation.  But  if  we  abstract 
from  real  crime,  we  certainly  have  to  acknowledge 
that  actions  can  be  performed  which  appear  in  strik- 
ing contrast  with  the  habits  and  character  of  the  nor- 
mal personality,  upset  his  knowledge,  and  are  based 
on  beliefs  which  would  be  immediately  rejected  under 
ordinary  conditions.  These  higher  degrees  of  hyp- 
notic state  are  easily  followed  by  complete  loss  of 
memory  for  all  that  happened  during  the  abnormal 
state. 

How  have  we  to  interpret  such  a  surprising  alter- 
ation of  mind?  It  lies  near  to  compare  it  with  sleep. 
The  brain  seems  powerless  to  produce  its  normal 
ideas,  the  associations  do  not  arise,  the  normal  im- 
pulses have  disappeared  and  a  general  ineffectiveness 
has  set  in;  in  short,  the  brain  cells  seem  unable  to 
function.  Of  course,  the  explanation  of  sleep  itself 
may  offer  difficulties.  Is  it  a  chemical  substance 
which  poisons  the  brain  during  the  sleep,  or  are  the 
brain  cells  contracted  so  that  the  excitement  cannot 
run  over  from  the  branches  of  one  nerve  cell  into 
those  of  another?  Or  are  the  blood-vessels  con- 
tracted so  that  an  anaemic  state  makes  their  normal 
function  impossible  ?  But  whatever  the  physical  con- 
dition of  sleep  may  be,  have  we  really  a  right  to  em- 


SUGGESTION  AND  HYPNOTISM     113 

phasize  the  similarity  between  sleep  and  hypnosis? 
After  all  that  we  have  discussed,  we  ought  rather  to 
recognize  that  the  hypnotic  state  too  comes  much 
nearer  to  the  process  of  attention  than  to  the  process 
of  sleep.  We  saw  that  in  every  act  of  attention  the 
process  of  inhibition  is  essential.  All  that  is  not  in 
harmony  with  the  attended  idea  is  suppressed.  Yet 
we  should  hesitate  to  say  that  in  attention  parts  of 
our  brain  are  asleep. 

We  should  feel  reluctance  to  group  such  inhibition 
together  with  sleep  because  it  would  be  a  sleep  which 
at  any  moment  can  pass  from  one  part  of  the  brain 
to  others  and  which  certainly  leaves  at  every  moment 
most  of  the  cell  groups  unaffected.  We  saw  that  at- 
tention does  not  at  all  focus  on  one  narrow  point,  but 
that  an  abundance  of  impressions,  of  ideas  and  as- 
sociations, of  thoughts  and  emotions^  can  enter  the 
field  of  attention,  if  they  all  lead  to  one  and  the  same 
motor  attitude,  and  that  only  the  one  part  is  inhibited 
which  involves  the  opposite  action.  Such  a  jumping 
sleep  which  at  every  moment  selects  a  special  part 
would  be,  of  course,  just  the  contrary  of  that  which 
characterizes  the  sleep  state  of  the  fatigued  brain. 
But  exactly  these  characteristics  of  attention  belong 
to  hypnotism  too.  It  is  not  true  that  the  mind  of  the 
hypnotized  is  asleep  and  that  perhaps  only  one  or  the 
other  idea  can  be  pushed  into  his  mind.  On  the  con- 
trary, his  mind  is  open  to  an  abundance  of  ideas,  just 
as  in  the  normal  state.  If  I  tell  him  that  this  is  a 
landscape  in  Switzerland,  he  sees  at  once  the  moun- 
tains and  the  lakes,  and  his  mind  provides  all  the  de- 


n4  PSYCHOTHERAPY 

tails  of  his  reminiscences,  and  his  imagination  fur- 
nishes plenty  of  additions.  His  whole  mind  is  awake; 
the  feelings  and  emotions  and  volitions,  the  memories 
and  judgments  and  thoughts  are  rushing  on,  and  only 
that  is  excluded  which  demands  a  contrary  attitude. 
This  selective  process  stands  decidedly  in  the  center 
of  the  hypnotic  experience  and  makes  it  very  doubtful 
whether  we  are  psychophysically  on  the  right  track, 
if  we  make  much  of  the  slight  similarity  between 
hypnosis  and  sleep. 

This  has  nothing  to  do  with  the  fact  that  hypnosis 
is  best  brought  about  by  suggesting  the  idea  of  sleep, 
that  is,  the  belief  that  sleep  will  set  in.  This  belief 
is  indeed  effective  in  removing  all  the  ideas  which  are 
awake  in  the  mind  which  would  interfere  with  the 
willingness  to  submit  to  the  suggestions  of  the  hypno- 
tizer.  But  the  fact  that  belief  in  sleep  and  expecta- 
tion of  sleep  bring  with  them  the  hypnotic  state  is 
not  a  proof  that  the  hypnotic  state  itself  is  sleep. 
Even  the  mental  experiences  which  can  remain  in  sleep, 
the  dreams,  are  characteristically  different  from  the 
hypnotic  experience.  Thus  the  dreams  show  that  un- 
selective  awakening  of  ideas  which  is  to  be  expected 
from  a  general  decrease  of  functioning.  The  hypnotic 
variation  is  characterized  just  by  its  selective  nar- 
rowing of  consciousness.  For  the  same  reason, 
hypnotism  is  strikingly  different  from  such  diseases  of 
the  mind  as  dementia.  Certainly  in  dementia  too, 
many  associations  are  cut  off,  but  it  is  not  a  selective 
inhibition,  it  is  a  haphazard  destruction  resulting 
from  the  degeneration  in  the  brain. 


SUGGESTION  AND  HYPNOTISM    115 

The  fundamental  principle  of  the  hypnotic  state 
lies  in  its  selective  character.  Inhibited  and  cut  off 
are  those  states  which  are  antagonistic  to  the  beliefs 
in  the  suggested  ideas,  and  as  their  antagonism  con- 
sists in  their  connection  with  opposite  actions,  the 
whole  is  again  a  question  of  motor  setting.  No 
doubt,  such  new  motor  setting  can  precede  the  normal 
sleep  too;  thus  the  sleeper  may  be  insensitive  to  any 
surrounding  noises,  but  perhaps  awake  at  the  slightest 
call  from  a  patient  who  is  intrusted  to  his  care.  In 
that  case,  one  special  feature  of  hypnotism  is  super- 
added  to  sleep  but  the  sleep  itself  is  not  hypnotic. 
Again  sleep  may  go  over  into  a  state  which  shares 
many  characteristic  features  with  hypnotism,  that  is, 
somnambulism,  and  it  may  be  said  with  a  certain 
truth  that  hypnotism  is  artificial  somnambulism.  But 
somnambulism,  while  arising  in  sleep,  is  not  at  all  a 
feature  of  sleep. 

While  sleep  is  characterized  by  a  decrease  of 
sensitiveness  and  of  selective  powers,  the  selective 
process  of  hypnotism  rather  reenforces  sensitiveness 
and  memory  in  every  field  which  is  covered  by  the 
suggestive  influence.  Stimuli  may  become  noticeable 
which  the  normal  man  is  unable  to  perceive,  and  long- 
forgotten  experiences  which  seem  inaccessible  to  the 
search  of  the  waking  mind  may  reproduce  themselves 
and  may  vividly  enter  consciousness.  Again  we  have 
there  symptoms  which  rather  characterize  the  state 
of  over-attention  than  the  state  of  sleep.  We  might 
add  further  that  we  know  states  with  all  the  character- 
istics of  hypnotism  in  which  even  the  subjective  idea 


n6  PSYCHOTHERAPY 

of  sleep  is  entirely  absent,  for  instance,  all  those 
which  are  usually  called  states  of  fascination.  A 
certain  shining  light  or  a  glimpse  of  an  uncanny  eye 
may  startle  and  upset  the  imagination  of  the  subject 
and  throw  him  into  a  state  of  abnormally  increased 
suggestibility.  It  is  well  known  that  whole  epi- 
demics of  such  captivation  have  occurred  and  have 
resulted  in  hysterias  of  the  masses  in  which  the  sub- 
jects become  the  slaves  of  their  impulse,  perhaps  to 
imitate  what  they  see  or  hear,  or  to  realize  ideas  in 
which  they  believe  without  logical  warrant.  They 
surely  are  not  asleep,  are  not  even  partially  asleep. 
Every  center  of  their  brains  would  be  ready  to  work, 
if  the  captivated  attention  were  not  forcing  the  mind 
in  one  direction  and  selectively  suppressing  every  im- 
pulse to  opposite  actions.  The  developed  hypnotism 
finally  shades  off  into  innumerable  states  of  hypnoid 
character  in  which  the  sleeplike  symptoms  are  entirely 
in  the  background. 

Thus  the  increased  suggestibility  of  the  hypnotic 
state  will  result  not  from  a  partial  sleeplike  decrease 
of  functioning  but  the  decrease  of  function  is  a  motor 
inhibition  which  results  from  over-attention.  In  the 
ordinary  attention,  our  motor  setting  secures  only  an 
increase  in  clearness  and  vividness  of  the  attended 
ideas,  but  in  an  abnormal  over-attention  the  new  mo- 
tor setting  produces  a  complete  acceptance  with  all  its 
consequences.  Abnormal  or  heightened  attention 
thus  goes  directly  over  into  the  belief  and  into  the  im- 
pulse without  resistance.  There  is  no  hypnotism 
which  does  not  contain  from  the  first  stage  this  defi- 


SUGGESTION  AND  HYPNOTISM    117 

nite  relation  to  certain  objects  of  attention,  usually 
to  a  particular  person.  All  the  manipulations,  passes, 
fixation,  monotonous  speaking,  and  so  on  narrow  the 
contents  of  consciousness  but  hold  the  idea  of  the 
hypnotizing  person  steadily  in  the  center  of  attention. 
The  awakened  expectation  of  sleep,  the  associated 
feeling  of  tiredness  all  help  to  cut  off  attention  from 
the  remainder  of  the  world,  but  as  no  real  sleep  sets 
in,  this  cutting  off  from  the  remainder  reenforces  the 
focusing  of  attention  on  the  one  central  idea  of  the 
hypnotizing  personality.  Every  word  and  every 
movement  of  this  personality  become  therefore  ab- 
sorbed with  that  over-attention  which  leads  at  once 
from  a  mere  perceiving  and  grasping  to  a  complete 
sinking  into  the  suggested  idea  with  the  suppression 
of  all  opposites,  and  thus  to  a  blind  acceptance  and 
belief.  We  saw  before  that  such  belief  is  indeed 
nothing  else  but  a  motor  setting  in  which  certain  ways 
of  action  are  prepared.  We  are  to  think  in  accord- 
ance with  the  belief  in  the  suggested  idea  and  the 
channels  for  discharge  in  the  opposite  direction  are 
closed.  Even  the  ordinary  life  shows  us  everywhere 
that  the__|tep  from  attention  to  belief  is  a  short  one. 
The  effort  to  grasp  the  object  clearly  works  as  a  sug- 
gestion to  accept  that  which  we  are  seeking  as  really 
existing,  and  that  from  which  we  are  to  abstract  and 
which  we  are  to  rule  out  through  our  attention,  we 
believe  to  be  non-existent.  The  prestidigitator  does 
his  tricks  in  order  to  sidetrack  our  attention,  but  he 
succeeds  in  making  us  believe  that  we  see  or  do  not 
see  whatever  he  wishes. 


n8  PSYCHOTHERAPY 

That  the  motor  setting  alone  determines  those 
changes  and  that  a  real  sleeplike  inability  of  the  cen- 
ters does  not  set  in,  can  also  be  demonstrated  by  the 
results  of  later  hypnotizations.  I  ask  my  hypnotized 
subject  not  to  perceive  the  friend  in  the  room;  he  is 
indeed  unable  to  see  him  or  to  hear  him.  Yet  his 
visual  and  acoustic  centers  are  not  impaired,  the  de- 
fect is  only  selective,  inasmuch  as  he  sees  me,  the 
hypnotizer,  and  not  the  friend.  But  even  this  selec- 
tion inhibits  only  the  attitude  and  not  the  sensorial 
excitement.  If  I  hypnotize  him  again  to-morrow 
and  suggest  to  him  now  to  remember  all  that  the 
friend  did  and  said  during  yesterday's  meeting,  he  is 
able  to  report  correctly  the  sense  impressions  which 
he  got,  which  were  inhibited  only  as  long  as  they  con- 
tradicted the  suggestion,  but  now  rush  to  conscious- 
ness as  soon  as  the  suggestion  is  reversed.  As  a  mat- 
ter of  course,  he  must  therefore  have  received  im- 
pressions through  eye  and  ear  in  his  hypnotic  sleep  of 
yesterday  from  all  that  happened,  only  he  was  not 
aware  of  it  because  the  channels  of  the  accepting  atti- 
tude were  blocked. 

As  soon  as  the  over-attention  has  produced  the  ac- 
ceptance of  the  belief,  all  further  effects  are  automatic 
and  necessary.  If  I  tell  the  hypnotized  person  that 
he  cannot  speak  and  he  absorbs  this  proposition,  with 
that  completeness  in  which  he  accepts  it  as  a  fact,  not 
speaking  itself  unavoidably  results.  The  motor  ideas 
with  which  the  speech  movement  has  to  start  are  cut 
off  and  the  subject  yields  passively  to  the  fate  that  he 
cannot  intonate  his  voice.  Thus  a  special  influence 


SUGGESTION  AND  HYPNOTISM     119 

on  the  will  is  in  no  way  involved.  If  the  idea  is 
accepted,  and  that  means,  if  the  preparatory  setting 
for  the  action  has  been  completed,  the  ideas  of  oppo- 
site activity  must  remain  ineffective;  the  suggested 
idea  must  discharge  itself  in  action  without  resistance. 
As  a  matter  of  course  the  new  line  of  action  will  then 
surround  Itself  with  its  own  associations  and  will  thus 
give  to  the  subject  the  impression  that  he  is  acting 
from  his  own  motives.  As  soon  as  the  psycho- 
physical  principles  are  understood,  there  is  indeed  no 
difficulty  in  going  from  the  simplest  experience  to 
those  spectacular  ones  where  we  may  suggest  to  the 
profoundly  hypnotized  person  that  he  is  a  little  child 
or  that  he  is  George  Washington.  In  the  one  case, 
he  will  speak  and  cry  and  play  and  write  as  in  his 
present  imagination  a  child  would  behave;  in  the 
other  case,  he  will  pose  in  an  attitude  which  he  may 
have  seen  in  a  picture  of  Washington.  There  is 
nothing  mysterious  and  his  utterances  are  completely 
dependent  upon  his  own  ideas,  which  may  be  very 
different  from  the  real  wisdom  of  a  Washington  and 
the  real  unwisdom  of  a  child.  I  may  suggest  to  him 
to  be  the  Czar,  by  that  he  will  not  become  able  to 
speak  Russian.  In  the  same  way  I  may  suggest 
changes  of  the  surroundings;  he  may  take  my  room 
for  the  river  upon  which  he  paddles  his  canoe,  or  for 
the  orchard  in  which  he  picks  apples  from  my  book- 
shelves. 

Finally  there  is  no  new  principle  involved,  if  the 
action  which  is  prepared  by  any  belief  has  to  set  in 
after  the  awaking  from  hypnotic  sleep,  the  so-called 


120  PSYCHOTHERAPY 

post-hypnotic  suggestion.  As  a  matter  of  course, 
just  these  have  an  eminent  value  for  psychotherapy. 
I  may  suggest  to-day  that  the  subject  will  overcome  to- 
morrow his  desire  for  the  morphine  injection,  or  that 
he  will  feel  to-night  the  restfulness  which  will  over- 
come his  insomnia.  But  if  the  suggestion  of  an  idea 
means  belief,  and  if  belief  means  a  preparation  for 
action,  we  have  indeed  no  new  factor  before  us  if  the 
action  for  which  we  prepare  the  subject  is  from  the 
start  related  to  a  definite  time.  If  we  do  not  link  it 
with  the  consciousness  of  a  special  time  or  of  a  special 
occasion  which  will  occur  later,  the  suggestion  soon 
fades  away.  That  my  library  is  an  orchard  is  for- 
gotten perhaps  within  ten  minutes,  if  I  have  not  come 
back  to  it  in  the  conversation.  But  if  I  say  that  after 
awaking  as  soon  as  I  shall  knock  on  my  desk  three 
times,  you  will  be  in  the  orchard  again,  the  psycho- 
physical  apparatus  is  prepared,  a  new  setting  has  set 
in,  the  three  knocks  will  bring  about  the  complete 
transformation.  In  short  the  difficulties  disappear 
as  soon  as  we  are  consistent  in  interpreting  all  sug- 
gestive influences  as  changes  in  the  motor  setting  and 
as  the  result  of  the  antagonistic  character  of  all  of 
our  motor  paths. 

We  say  the  difficulties  disappear.  Of  course,  that 
is  meant  in  a  relative  sense  only.  It  means  essentially 
that  we  are  able  to  bring  the  complex  state  of  hypno- 
tism down  to  the  similar  state  of  attention  and  motor 
adjustment,  but  of  course  we  must  not  forget  that 
we  are  far  from  a  satisfactory  explanation  of  the  proc- 
ess in  attention  itself.  We  know  that  the  opening  of 


SUGGESTION  AND  HYPNOTISM     121 

motor  channels  in  one  direction  somewhat  closes  the 
channels  for  discharge  in  the  opposite  direction,  but 
what  mechanism  does  that  work  is  still  very  obscure. 
Whichever  principle  of  hypothetical  explanation  we 
might  prefer,  it  certainly  leads  to  difficulties  in  view 
of  the  extreme  complexity  of  attention  in  states  of 
suggestion  and  hypnotism.  We  might  think  of  a 
mechanism  which  through  the  medium  of  the  finest 
blood-vessels  should  produce  a  localized  anaemia  in 
those  centers  which  lead  to  the  antagonistic  action. 
Or  we  might  fancy  that  by  extremely  subtle  ma- 
chinery the  resistance  is  increased  in  those  tissues 
which  lie  between  the  various  neurons,  or  we  might 
even  think  of  toxic  and  antitoxic  processes  in  the 
cerebral  regions;  and  any  day  may  open  entirely  new 
ways  of  explanation.  We  may  add  that  even  if  the 
mechanism  of  attention  were  completely  explained, 
we  are  also  still  far  from  understanding  the  physio- 
logical changes  which  go  on  in  the  sphere  of  the 
blood-vessels  or  of  the  glands  and  the  internal  organs. 
We  understand  easily  that  the  idea  of  the  subject  that 
he  cannot  move  his  arm  keeps  the  arm  stiff;  but  that 
his  idea  to  blush  really  dilates  the  blood-vessels  of  his 
cheek  is  much  less  open  to  our  causal  understanding; 
still  less  that  in  very  exceptional  cases  perhaps  a  part 
of  the  skin  becomes  inflamed,  if  we  make  believe  that 
we  touch  it  with  a  glowing  iron.  And  yet  here  too 
we  see  that  we  move  in  the  same  direction  and  that 
we  have  to  explain  these  exceptional  and  bewil- 
dering results  by  comparing  them  with  the  sim- 
pler and  simpler  forms,  that  the  process  of  atten- 


122  PSYCHOTHERAPY 

tion  contains  all  the  germs  for  the  whole  devel- 
opment. 

In  claiming  that  hypnotism  depends  upon  the  over- 
attention  to  the  hypnotizing  person,  we  admit  that 
the  increased  suggestibility  belongs  entirely  to  sug- 
gestions which  come  from  without.  Only  that  which 
at  least  takes  its  starting  point  from  the  words  or  the 
movements  of  the  hypnotizer  finds  over-sensitive  sug- 
gestibility. Ideas  which  arise  merely  from  the  as- 
sociations of  the  subject  himself  have  no  especially 
favorable  chance  for  acceptance.  But  surely  we  also 
know  states  in  which  the  suggestibility  for  certain  of 
one's  own  ideas  is  abnormally  increased.  Great  in- 
dividual differences  exist  in  that  respect  in  normal 
life.  There  are  normal  hypochondriacs  who  believe 
that  they  feel  the  symptoms  of  widely  different 
diseases  under  the  influence  of  their  own  ideas,  and 
others  who  are  torturing  themselves  with  fears  on  ac- 
count of  unjustified  beliefs.  But  the  abnormal  in- 
crease of  suggestibility  parallel  to  that  of  hypnotism 
for  suggestions  from  without  exists  for  suggestions 
from  within,  mainly  in  nervous  diseases,  especially  in 
neurasthenic,  hysteric,  and  psychasthenic  states.  With- 
in certain  limits,  we  might  almost  say  that  this  in- 
crease of  suggestibility  for  autosuggestion  is  the 
fundamental  characteristic  of  these  diseases,  just  as 
increase  of  suggestibility  for  heterosuggestions  char- 
acterizes hypnotism. 

Especially  in  earlier  times,  the  theory  was  often 
proposed  that  hypnosis  is  an  artificial  hysteria.  Such 
a  view  is  untenable  to-day;  but  that  hysteria  too  shows 


SUGGESTION  AND  HYPNOTISM     123 

abundant  effects  of  increased  suggestibility  is  cor- 
rectly indicated  by  such  a  theory.  The  hysteric  pa- 
tient may  by  any  chance  pick  up  the  idea  that  her 
right  arm  is  paralyzed  or  is  anaesthetic  and  the  idea 
at  once  transforms  itself  into  a  belief  and  the  belief 
clings  to  her  like  an  obsession  and  produces  the  effect 
that  she  is  unable  to  move  the  arm  or  that  she  does 
not  feel  a  pinprick  on  the  skin.  These  autosug- 
gestions may  take  a  firmer  hold  of  the  mind  than  any 
suggestions  from  without,  but  surely  such  openness  to 
selfimplanted  beliefs  must  be  acknowledged  as 
symptomatic  of  disease,  while  hypnosis  with  its  im- 
positions can  be  broken  off  at  any  moment  and  thus 
should  no  more  be  classed  among  the  diseases  than 
are  sleep  and  dreams.  The  hysteric  or  psychasthenic 
autosuggestion  resists  the  mere  will  of  breaking  it 
off.  Here,  therefore,  is  the  classical  ground  for 
strong  mental  counterinfluences,  that  is,  for  psycho- 
therapeutic  treatment.  Experience  shows  that  the 
strongest  chance  for  the  development  of  such  auto- 
suggestive  beliefs  exists  wherever  an  emotional  dis- 
position is  favorable  to  the  arriving  belief.  But  emo- 
tion too  is  after  all  fundamentally  a  motor  reaction. 
The  whole  meaning  of  emotion  in  the  biological  sense 
is  that  it  focuses  the  actions  of  man  into  one  chan- 
nel, cutting  off  completely  all  the  other  impulses  and 
incipient  actions.  Emotion  is  therefore  for  the  ex- 
pressions of  man  what  attention  is  for  the  impressions. 
An  emotional  disposition  means  thus  in  every  case  a 
certain  motor  setting  by  which  transition  to  certain 
actions  is  facilitated.  It  is  thus  only  natural  that  a 


i24  PSYCHOTHERAPY 

belief  can  settle  the  more  easily,  the  more  it  is  favored 
by  an  emotional  disposition,  as  the  motor  setting  for 
the  one  must  prepare  the  other.  Hypnosis  and  hys- 
teria thus  represent  the  highest  degrees  of  suggesti- 
bility, the  one  artificial,  the  other  pathological;  the 
one  for  suggestions  from  without,  the  other  for  sug- 
gestions from  within.  But  between  these  two  and 
the  normal  state  there  lie  numberless  steps  of  transi- 
tion. The  normal  variations  themselves  may  go  to 
a  limit  where  they  overlap  the  abnormal  artificial 
product,  that  is,  the  suggestibility  of  many  normal 
persons  may  reach  a  degree  in  which  they  accept  be- 
liefs hardly  acceptable  to  other  persons  in  mild 
hypnotic  condition.  Thus  there  is  no  sharp  demar- 
cation between  suggestions  in  a  waking  state  and 
suggestions  in  a  hypnoid  state.  And  the  expecta- 
tion of  coming  under  powerful  influence  may  produce 
a  sufficient  change  in  the  motor  setting  to  realize  any 
wonders.  Moreover  probably  every  physician  who 
has  a  long  experience  in  hypnotizing  has  found  that 
his  confidence  in  the  effectiveness  of  the  deep  hypnotic 
states  has  been  slowly  diminished,  while  his  belief  in 
the  surprising  results  of  slight  hypnotization  and  of 
hypnoid  states  has  steadily  grown  and  has  encouraged 
him  in  his  psychotherapeutic  efforts. 


VI 

I 

THE  SUBCONSCIOUS 

THE  story  of  the  subconscious  mind  can  be 
told  in  three  words:  there  is  none.  But  it 
may  need  many  more  words  to  make  clear 
what  that  means,  and  to  show  where  the  misunder- 
standing of  those  who  give  to  the  subconscious  al- 
most the  chief  role  in  the  mental  performance  sets  in. 
The  psychology  of  suggestion,  for  instance,  which  we 
have  now  fully  discussed  without  even  mentioning 
the  word  subconscious,  figures  in  most  popular  books 
in  the  treatises  of  both  physicians  and  ministers  as  a 
wonderful  dominance  of  the  subconscious  mind.  The 
subconscious  mind  alone  receives  the  suggestions  and 
makes  them  effective,  the  subconscious  mind  controls 
the  suggestive  processes  in  consciousness,  and  the  sub- 
conscious mind  comes  into  the  foreground  and  takes 
entire  hold  of  the  situation  when  the  hypnotic  state 
sets  in. 

But  we  are  always  assured  that  there  is  no  need  of 
turning  to  the  mystery  of  suggestion  and  hypnotism 
to  find  that  uncanny  subpersonality  in  us.  We  try 
to  remember  a  name,  or  we  think  of  the  solution  of  a 
problem ;  what  we  are  seeking  does  not  come  to  con- 
sciousness and  now  we  turn  to  other  things ;  and  sud- 

125 


i26  PSYCHOTHERAPY; 

denly  the  name  flashes  up  in  our  mind  or  the  solution 
of  the  problem  becomes  clear  to  us.  Who  can  doubt 
that  the  subconscious  mind  has  performed  the  act? 
While  our  attention  was  given  over  to  other  ques- 
tions, the  subconscious  mind  took  up  the  search  and 
troubled  itself  with  the  problem  and  neatly  performed 
what  our  conscious  mind  was  unable  to  produce. 
Moreover  in  every  situation  we  are  performing  a 
thousand  useful  and  welladapted  acts  with  our  body 
without  thinking  of  the  end  and  aim.  What  else  but 
the  subconscious  mind  directs  our  steps,  controls  our 
movements,  and  adjusts  our  life  to  its  surroundings? 
And  is  not  every  memory  picture,  every  reminiscence 
of  earlier  experiences  a  sufficient  proof  that  the  sub- 
conscious mind  holds  its  own?  The  poem  which  we 
learned  years  ago  did  not  remain  somewhere  lingering 
in  our  consciousness,  and  if  we  can  repeat  it  today, 
it  must  be  because  our  subconscious  mind  has  kept  it 
carefully  in  its  store  and  is  ready  to  supply  us  when 
consciousness  has  need  for  it. 

Surely  if  we  think  how  this,  our  subconscious  mind, 
is  able  to  hold  all  our  memories  and  all  our  learning, 
and  how  it  transacts  all  the  work  of  controlling  our 
useful  actions  and  of  bringing  up  the  right  ideas,  we 
may  well  acknowledge  that  compared  with  it  our 
conscious  life  is  rather  a  small  part.  It  is  as  with  the 
iceberg  in  the  ocean ;  we  know  that  only  a  small  part 
is  visible  above  the  surface  of  the  water  and  a  ten 
times  larger  mountain  swims  below  the  sea.  It  seems, 
therefore,  only  logical  to  attach  this  whole  subcon- 
scious mental  life  to  a  special  subconscious  personal- 


THE  SUBCONSCIOUS  127 

ity.  Then  we  come  to  the  popular  theory  of  the  two 
minds  in  us,  the  upper  and  the  lower,  of  which  we  can 
hardly  doubt  that  the  lower  one  has  on  the  whole  the 
larger  part  of  the  business  to  perform.  And  we  cer- 
tainly have  no  right  to  give  to  the  word  lower  mind 
the  side-meaning  that  the  activity  is  of  a  lower  order. 
The  most  brilliant  thoughts  of  the  genius  are  not 
manufactured  in  his  upper  consciousness,  they  spring 
suddenly  into  his  mind,  their  whole  creation  belongs 
thus  to  the  assiduous  work  of  the  subconscious  neigh- 
bor. There  the  inventor  and  discoverer  gets  his 
guidance,  there  the  poet  gets  his  inspiration,  there 
the  religious  mind  gets  its  beliefs.  In  short, 
the  constitution  of  the  mental  state  allows  on 
the  whole  to  the  upper  consciousness  a  rather  deco- 
rative part  while  the  real  work  is  left  for  the  lower 
house. 

Yet  it  must  be  acknowledged  that  the  scholars 
somewhat  disagree  as  to  the  dignity  of  the  lower 
mind.  Considering  the  usually  accepted  fact  that  in 
hypnotism  the  lower  mind  comes  entirely  over  the 
surface,  just  these  hypnotic  events  can  indeed  suggest 
two  different  views  of  the  subconscious  and  this  dou- 
bleness  is  reenforced  if  we  still  add  the  entertaining 
material  which  comes  to  light  by  the  automatic  writ- 
ing of  mediums  in  their  trance.  The  hypnotized 
person  is  ready  to  perform  any  foolishness,  is  not 
influenced  by  any  considerations  of  tact  and  taste 
and  wisdom  and  respect,  and  thus  some  of  the  chief 
believers  in  the  subconscious  personality  stick  to  the 
diagnosis  that  the  lower  mind  in  us  which  shows  up 


128  PSYCHOTHERAPY 

in  hypnotism  is  a  rather  brutal,  stupid,  lazy,  cow- 
ardly, immoral  creature  which  ordinarily  rather  de- 
serves to  be  subdued  by  our  noble  and  wise  upper 
personality.  And  the  automatic  writings  of  the  me- 
diums indorse  this  disrespectful  view,  for  it  is  diffi- 
cult to  gather  more  idiotic  slang  than  the  emanations 
of  these  letters  of  the  planchette.  On  the  other  hand, 
the  hypnotized  person  shows  an  increase  of  sensitive- 
ness and  hyperaesthesia  in  which  perhaps  optical  im- 
pressions or  smells  may  be  noticed  which  the  ordinary 
man  cannot  perceive.  Moreover  the  memory  of  the 
hypnotized  is,  as  we  saw,  abnormally  sharpened. 
Entirely  forgotten  experiences  may  awake  again. 
The  same  holds  true  for  the  hysteric  in  whom  also, 
of  course,  the  subconscious  takes  hold  of  the  inner 
life.  Thus  it  seems  entirely  safe  to  say  that  the 
powers  of  the  subconscious  personality  far  surpass 
those  of  the  upper  conscious  fellow,  and  that  agrees 
with  all  those  facts  as  to  the  subconscious  origin  of 
the  work  of  the  genius.  Further,  has  it  not  been 
found  again  and  again  that  the  hypnotized  and  the 
hysteric  cannot  only  remember  long-forgotten  parts 
of  the  past  but  have  telepathic  knowledge  for  dis- 
tant events  and  even  mysterious  premonitions  of  the 
field  of  occurrences  of  the  future? 

Hypnotism  is  essentially  the  same  as  the  old  mes- 
merism, and  mesmerism  was  widely  acknowledged 
as  clairvoyance,  and  all  that  harmonizes  again  with 
the  experiences  of  the  mediums  whose  subconscious 
mind  in  trance  enters  into  contact  with  the  spirits  of 
the  dead.  The  subconscious  personality  is  thus  really 


THE  SUBCONSCIOUS  129 

a  metaphysical  power  which  transcends  the  limita- 
tions of  the  earthly  person  altogether  and  has  steady 
connection  with  the  endless  world  of  spirit  and  the 
inner  soul  of  the  universe.  Most  popular  books,  it 
is  true,  do  not  demand  from  their  readers  the  choice 
between  the  one  or  the  other  type  of  the  lower  per- 
sonality, between  that  brutal,  vicious,  ignorant  crea- 
ture and  that  far-seeing,  inspired,  powerful  soul. 
They  simply  mix  the  two  and  adapt  the  special  facul- 
ties of  this  underground  man  to  the  special  require- 
ments of  the  particular  chapter,  the  subconscious  being 
unusually  wise  or  unusually  stupid  in  accordance  with 
the  special  facts  which  are  just  then  to  be  explained. 
Even  that  does  not  always  settle  all  difficulties.  They 
may  discover,  for  instance,  that  the  subconscious 
mind  with  which  we  deal  in  the  hypnotized  person 
has  again  itself  a  subconsciousness.  If  we  tell  the 
hypnotized  person  not  to  see  a  certain  picture  on  the 
wall,  this  subconscious  personality  perceives  the  whole 
room  with  the  exception  of  the  picture.  Yet  after  all 
someone  sees  this  picture,  because  if  we  hypnotize  him 
the  next  time  and  ask  him  what  the  picture  contained, 
he  now  knows  its  contents.  Thus  they  must  have  been 
recognized  in  a  sub-subconsciousness,  and  we  there- 
fore come  to  a  personality  which  lives  on  a  floor  still 
below  the  basement.  But  experiment  can  demon- 
strate that  even  this  most  hidden  personality  has 
still  its  secrets  which  are  handed  downwards.  In 
short,  we  finally  have  not  merely  two  but  a  number 
of  personalities  in  us. 

But  now  let  us  leave  these  fantasies  of  psycholog- 


i3o  PSYCHOTHERAPY 

ical  fiction.  Let  us  turn  to  the  concrete  facts,  let  us 
see  them  in  the  spirit  of  modern  scientific  psychology, 
let  us  try  to  explain  them  in  harmony  with  the  prin- 
ciples of  psychological  explanation,  and  let  us  dis- 
criminate the  various  groups  of  facts  which  have  led 
to  that  easy-going  hypothesis  of  the  subconscious. 
Discrimination  indeed  is  needed,  as  it  would  be  im- 
possible to  bring  the  whole  manifold  of  facts  under 
one  formula,  but  there  is  certainly  no  unification 
reached  by  simply  putting  the  same  label  on  all  the 
varieties  and  behaving  as  if  they  are  all  at  once  ex- 
plained when  they  are  called  the  functions  of  the  sub- 
conscious. Two  large  groups  may  be  separated. 
Facts  are  referred  to  the  subconscious  mind  which  do 
not  belong  to  the  mind  at  all,  neither  to  a  conscious 
nor  to  a  subconscious  one,  but  which  are  simply 
processes  in  the  physical  organism ;  and  secondly,  facts 
are  referred  to  the  subconscious  mind  which  go  on  in 
the  conscious  mind  but  which  are  abnormally  con- 
nected. Thus  the  subconscious  mental  facts  are  either 
not  mental  but  physiological,  or  mental  but  not  sub- 
conscious. 

What  does  the  scientific  psychologist  really  mean 
by  consciousness?  We  must  now  think  back  to  our 
discussion  of  the  principles  which  control  the  funda- 
mental conceptions  of  modern  psychology.  We  saw 
clearly  that  the  psychology  which  is  a  descriptive  and 
explanatory  science  of  mental  phenomena  can  by  no 
means  have  the  ambition  to  be  a  full  interpretation 
of  the  inner  reality.  Our  inner  life,  we  saw,  is  not  a 
series  of  phenomena,  is  not  a  chain  of  objects  which 


THE  SUBCONSCIOUS  131 

we  are  aware  of  and  which  we  therefore  can  describe, 
and  which  finally  we  can  explain.  But  in  its  living 
reality,  we  saw  that  it  is  purposive,  has  a  meaning 
and  aim,  is  will  and  intention,  and  can  thus  be  under- 
stood in  its  true  character,  not  by  describing  and 
explaining  it  but  by  interpreting  it  and  appreciat- 
ing it.  This  is  the  life  attitude  towards  personalities 
when  we  deal  man  to  man.  We  do  not  at  first  con- 
sider ourselves  or  our  fellows  as  mental  objects  to 
be  explained  but  always  as  subjects  to  be  understood 
in  their  meaning.  If  we  pass  from  this  primary  atti- 
tude to  the  attitude  of  the  scientific  psychologist  we 
gain,  as  we  saw,  an  artificial  perspective.  We  must 
consider  then  our  inner  experience  of  ourselves  with 
all  our  states  as  a  series  of  objects  made  up  of  ele- 
ments connected  by  law.  Instead  of  the  real  things 
which  in  our  real  life  are  objects  of  will  and  pur- 
pose, tools  and  means  for  us,  the  psychologist  knows 
only  objects  of  awareness,  objects  which  have  no 
meaning,  but  which  simply  exist  and  which  are  no 
longer  related  to  a  will  but  are  connected  with  other 
objects  as  causes  and  effects.  Now  we  deal  no  longer 
with  the  chairs  and  tables  before  us  but  from  a 
psychological  point  of  view  they  become  perceptive 
ideas  of  chairs  and  tables,  ideas  which  are  not  in  the 
room  but  in  our  own  minds.  While  these  objects  of 
our  will  and  of  our  personality  become  mere  ideas, 
our  will  and  personality  themselves  become,  too,  a 
series  of  phenomena.  Our  self  is  now  no  longer  the 
purposive  will  but  is  that  group  of  sensations  and 
ideas  which  clusters  about  the  perception  of  our  organ- 


132  PSYCHOTHERAPY 

ism  and  its  actions;  in  short,  our  self  itself  becomes 
an  object  of  awareness. 

Our  whole  inner  experience  thus  becomes  a  mani- 
fold of  objects.  Our  self  and  the  actions  of  our  self 
are  thus  alike  for  the  psychologist  mere  phenomena, 
mere  objects  which  are  perceived.  Will  and  emotion, 
memory  idea  and  thought — they  all  are  now  passing 
appearances  like  the  sunshine  and  rain,  the  flowers 
and  waves.  By  this  transformation  the  immediate 
will  character  of  real  life  is  given  up,  but  instead  of 
it  a  system  of  objects  is  gained,  that  allows  descrip- 
tion and  explanation.  If  we  are  to  deal  at  all  with 
inner  life  not  from  a  purposive  but  from  a  causal 
point  of  view,  we  are  obliged  to  admit  this  recon- 
struction. Without  it  we  cannot  have  any  science 
of  the  mind,  without  it  we  can  understand  the  inten- 
tions of  our  neighbor  and  appreciate  the  truth  and 
morality  of  his  meanings  but  we  cannot  causally  ex- 
plain his  experiences  or  determine  which  effects  are 
to  be  expected.  It  is  thus  not  an  arbitrary  substitu- 
tion but  a  procedure  just  as  necessary  and  logically 
obligatory  as  the  work  of  the  chemist  who  substitutes 
trillions  of  invisible  atoms  for  the  glass  of  water 
which  he  drinks.  The  possibility  of  causal  explana- 
tion of  the  successive  facts  demands  this  remolding 
of  the  outer  and  of  the  inner  world.  We  have  dis- 
cussed that  before  and  now  only  have  to  draw  the 
consequences. 

Thus  for  the  psychologist  the  mental  world  is  a 
system  of  mental  objects.  To  be  an  object  means  of 
course  to  be  object  of  some  subject  which  is  aware  of 


THE  SUBCONSCIOUS  133 

it.  What  else  could  it  mean  to  exist  at  all  as  object 
if  not  that  it  is  given  to  some  possible  subject?  But 
the  world  of  objects  is  twofold;  we  have  not  only  the 
mental  objects  of  the  psychologist  but  also  the  phys- 
ical objects  of  the  naturalist.  Science  must  character- 
ize the  difference  between  those  two  and  we  pointed 
once  before  to  the  only  fundamental  difference. 
Physical  objects  are  those  which  are  possible  objects 
of  awareness  for  every  subject;  psychical  objects  are 
those  which  are  possible  objects  of  awareness  for  one 
subject  only.  The  tree  which  I  see  is  as  physical  tree 
object  for  every  man,  it  is  the  same  tree  which  you 
and  I  see;  my  psychical  perception  of  the  tree  is  ob- 
ject for  one  subject  only.  My  perception  can  never 
be  your  perception.  Our  perceptions  may  agree  but 
each  has  his  own.  As  to  the  physical  objects,  we  can 
entirely  abstract  from  such  reference  to  the  subjects. 
We  say  simply:  the  tree  exists  or  is  part  of  nature; 
and  only  the  philosopher  is  aware  that  we  silently 
mean  by  it  that  it  exists  for  every  subject  and  that  it 
is  therefore  not  necessary  to  refer  to  any  particular 
subject.  But  the  perception  of  the  tree  which  is  either 
your  idea  or  my  idea  evidently  gets  its  existence  only 
if  it  is  referred  and  attached  to  a  particular  subject 
which  is  aware  of  it.  Such  subject  of  awareness  is 
that  which  the  psychologist  calls  consciousness  and  all 
the  ideas  and  volitions  and  emotions  and  sensations 
and  images  which  make  up  the  mental  life  are  then 
contents  of  the  consciousness  or  objects  of  the  con- 
sciousness. To  have  psychical  existence  at  all  means 
thus  to  be  object  of  awareness  for  a  consciousness. 


i34  PSYCHOTHERAPY, 

Something  psychical  which  simply  exists  but  is  not  ob- 
ject of  consciousness  is  therefore  an  inner  contradic- 
tion. Consciousness  is  the  presupposition  for  the  ex- 
istence of  the  psychical  objects.  Psychical  objects 
which  enjoy  their  existence  below  consciousness  are 
thus  as  impossible  as  a  wooden  piece  of  iron. 

If  consciousness  is  nothing  but  the  subject  of  aware- 
ness for  the  individual  objects,  we  see  at  once  certain 
consequences  which  are  too  often  forgotten  in  the 
popular,  haphazard  psychology.  In  the  scientific  sys- 
tem of  psychology,  consciousness  has  for  instance 
nothing  whatever  to  perform,  that  is,  consciousness 
itself  is  in  no  way  active.  The  active  personality  of 
real  life  has  been  left  behind  and  has  itself  been  trans- 
formed into  that  self  which  is  merely  content  of  con- 
sciousness. The  person  who  acts  and  performs  the 
deeds  of  our  life  is  then  only  a  central  content  of  our 
consciousness  which  is  crystallized  about  the  idea  of 
our  organism.  It  has  thus  become  one  of  the  con- 
tents of  which  consciousness  itself  is  passively  aware. 
Consciousness  is  an  inactive  spectator  for  the  proces- 
sion of  the  contents.  Thus  consciousness  itself  can- 
not change  anything  in  the  content  nor  can  it  connect 
the  contents.  No  other  function  is  left  to  conscious- 
ness but  merely  that  of  awareness.  Every  change 
and  every  fusion  and  every  process  must  be  explained 
through  the  relations  of  the  various  contents  to  one 
another.  Consciousness  has,  therefore,  not  the  power 
to  prefer  the  one  idea  or  to  reject  the  other,  to  re- 
enforce  the  one  sensation  and  to  inhibit  the  other. 
From  a  psychological  point  of  view,  we  have  seen 


THE  SUBCONSCIOUS  135 

before  that  even  attention  does  not  mean  an  activity 
of  consciousness  but  a  change  in  the  content  of  con- 
sciousness. Certain  sensations  become  more  impres- 
sive, more  clear,  and  more  vivid,  and  others  fade 
away,  become  indistinct  and  disappear,  but  all  that 
goes  on  in  the  content  of  consciousness  and  the 
spectator,  consciousness  itself,  simply  becomes  aware 
of  those  changes.  Consciousness  has  also  in  itself  no 
special  span,  ideas  appear  or  disappear  not  because 
consciousness  expands  or  narrows  itself  but  because 
the  causal  conditions  awaken  or  suppress  the  various 
contents. 

Consciousness  has  in  itself  no  limit;  all  organiza- 
tion belongs  to  the  content.  Whatever  psychical 
states  are  attributed  to  one  organism  belong  thus  to 
its  consciousness  but  all  the  connections  are  entirely 
connections  of  the  content.  We,  therefore,  have  not 
even  the  right  to  say  that  consciousness,  as  such,  has 
unity.  Unity  too  belongs  to  the  organization  of  the 
content.  One  part  of  the  content  hangs  together 
with  the  other  parts  but  consciousness  is  only  the  con- 
stant condition  for  their  existence.  Where  there  is 
no  unity,  there  it  cannot  have  any  meaning  to  speak 
of  the  double  or  triple  existence.  There  may  be  a  dis- 
connection in  the  various  parts  of  the  content  and  a 
dissociation  by  which  the  normal  ties  between  the  vari- 
ous contents  may  be  broken  but  consciousness  itself 
cannot  fall  asunder.  Thus  consciousness  cannot  have 
any  different  degrees.  The  same  consciousness  experi- 
ences the  distinct  clear  content  and  the  vague  fading 
confused  content.  Thus  also  consciousness  can  never 


136  PSYCHOTHERAPY 

be  aware  of  itself  and  the  word  self-consciousness  is 
easily  misleading.  In  psychology,  it  can  never  mean 
that  the  consciousness  which  is  a  subject  of  all  experi- 
ence is  at  the  same  time  object  of  any  experience. 
Its  whole  meaning  lies  in  its  being  the  passive  spec- 
tator. That  of  which  consciousness  becomes  aware  in 
self-consciousness  is  the  idea  of  the  personality,  which 
is  certainly  a  content.  The  personality,  the  actor 
of  our  actions,  is  thus  never  anything  but  an  object 
in  psychology,  and  consciousness  never  anything  but 
a  subject.  Consciousness  itself  is  thus  in  no  way 
altered  when  the  idea  of  the  personality  is  changing. 
Only  if  all  this  is  carelessly  confused,  if  consciousness 
is  sometimes  treated  as  meaning  subject  of  conscious- 
ness, and  at  another  time  as  meaning  the  content  of 
consciousness,  and  again  at  another  time  the  unified 
organization  of  the  content,  and  at  still  another  time 
the  connection  of  the  content  with  the  personality,  and 
if  finally  all  that  is  confused  with  the  purposive  reality 
of  the  immediate  personal  life — only  then,  do  we  find 
the  way  open  to  those  tempting  theories  of  the  sub- 
conscious personality. 

If,  instead,  we  stick  to  the  scientific  view,  we  find 
the  following  facts.  First,  we  have  everywhere  with 
us  the  fact  that  the  earlier  experiences  may  again 
enter  into  consciousness  as  memory  images  or  as 
imaginative  ideas,  that  is,  in  the  order  in  which  they 
are  experienced  a  long  time  before  or  in  a  new  order, 
either  with  a  feeling  of  acquaintance  or  without  it. 
Certainly  at  no  time  is  the  millionth  part  of  what  we 


THE  SUBCONSCIOUS  137 

may  be  able  to  reproduce  present  in  our  consciousness. 
Where  are  those  words  of  the  language,  those  faces 
of  our  friends,  those  landscapes,  and  those  thoughts; 
where  have  they  lingered  in  the  time  of  their  seclu- 
sion? Scientific  psychology  has  no  right  to  propose 
any  other  theory  as  explanation  but  that  no  mental 
states  at  all  remain  and  that  all  which  remained  was 
the  disposition  of  physiological  centers.  When  I 
coupled  the  impression  of  a  man  with  the  sound  of 
his  name,  a  certain  excitement  of  my  visual  centers 
occurred  together  with  the  excitement  of  my  acous- 
tical centers;  the  connecting  paths  became  paths  of 
least  resistance,  and  any  subsequent  excitement  of  the 
one  cell  group  now  flows  over  into  the  other.  It  is 
the  duty  of  physiology  to  elaborate  such  a  clumsy 
scheme  and  to  make  us  understand  in  detail  how  those 
processes  in  the  neurons  can  occur  and  it  is  not  the 
duty  of  psychology  to  develop  detailed  physiological 
hypotheses.  Psychology  has  to  be  satisfied  with  the 
fact  that  all  the  requirements  of  the  case  can  be  fur- 
nished by  principle  through  physiological  explanation. 
Least  of  all  ought  we  to  be  discouraged  by  the  mere 
complexity  of  the  process.  If  a  simple  sound  and  a 
simple  color  sensation,  or  a  simple  taste  and  simple 
smell  sensation,  can  associate  themselves  through  mere 
nervous  conditions  of  the  brain,  then  there  is  nothing 
changed  by  going  over  to  more  and  more  complex 
contents  of  consciousness.  We  may  substitute  a  whole 
landscape  for  a  color  patch  or  the  memory  of  a  book 
for  a  word,  but  we  do  not  reach  by  that  a  point  where 
the  physiological  principle  of  explanation,  once  ad- 


i3  8  PSYCHOTHERAPY 

mitted,  begins  to  lose  its  value.  Complexity  is  cer- 
tainly in  good  harmony  with  the  bewildering  mani- 
foldness  of  those  thousands  of  millions  of  possible 
connections  between  the  brain  cells. 

Every  experience  leaves  the  brain  altered.  The 
nerve  fibers  and  the  cells  have  gone  into  new  stages 
of  disposition  for  certain  excitements.  This  dis- 
position may  be  slowly  lost.  In  that  case  the  earlier 
experience  cannot  be  reproduced;  we  have  forgotten 
it.  But  as  long  as  the  disposition  lasts — it  is  quite 
indifferent  whether  we  conceive  it  more  in  terms  of 
chemical  changes  or  physical  variations,  as  processes 
in  the  nerve  cells  or  between  the  nerve  cells — the 
physiological  change  alone  is  responsible  for  the 
awakening  of  the  memory  idea  under  favoring  asso- 
ciative conditions.  Of  course,  someone  might  reply : 
can  we  not  fancy  that  there  remains  on  the  psychical 
side  also  a  disposition?  Each  idea  which  we  have 
experienced  may  have  left  a  psychical  trace  which 
alone  may  make  it  possible  that  the  idea  may  come 
back  to  us  again.  But  what  is  really  meant  and  what 
is  gained  by  such  a  hypothesis  ? 

First,  do  not  let  us  forget  that  such  a  proposition 
could  only  have  one  possible  end  in  view,  namely, 
the  explanation  of  the  reappearance  of  memories. 
But  when  we  discussed  the  basis  of  physiological 
psychology,  we  convinced  ourselves  that  mental  facts 
as  such  are  not  causally  connected  anyhow.  Our  real 
inner  life  has  its  internal  connections,  connections  of 
will  and  purpose,  but  as  soon  as  we  have  taken  that 
great  psychological  step  and  look  on  inner  life  as 


THE  SUBCONSCIOUS  139 

merely  psychological  objects,  then  the  material  is  con- 
nected only  through  the  underlying  physiological 
processes  and  we  can  never  explain  causally  the 
appearance  of  an  idea  through  the  preceding  exist- 
ence of  another  idea.  We  may  expect  one  after  the 
other,  but  we  have  no  insight  into  the  mechanism 
which  makes  the  second  follow  after  the  first.  Such 
insight  into  necessary  connection  we  find  only  on  the 
physical  side,  and  we  saw  that  just  here  lies  the  start- 
ing point  for  the  modern  view  of  physiological 
psychology.  If  that  holds  true  for  the  connections 
between  idea  and  idea,  of  course  it  holds  true  in  the 
same  way  for  the  connection  between  mental  dis- 
position and  the  corresponding  memory.  We  can 
understand  causally  that  alchemical  disposition  in  the 
nerve  fibers  brings  about  a  chemical  excitement  in 
those  neurons,  but  how  a  mental  disposition  is  to 
create  mental  experience  we  could  not  understand; 
and  to  explain  it  casually,  we  should  need  again  a 
reference  to  the  underlying  physiological  processes. 
The  hypothesis  of  mental  dispositions  would  thus  be 
an  entirely  superfluous  addition  by  which  we  trans- 
cend the  real  experience  without  gaining  anything 
for  the  explanation. 

Secondly,  if  we  really  needed  a  mental  disposition 
for  each  memory  picture,  in  addition  to  the  physio- 
logical disposition  of  the  brain  cells,  can  we  overlook 
that  exactly  the  same  thing  would  then  be  necessary 
for  every  perception  also?  The  outer  impression 
produces,  perhaps  through  eye  or  ear  or  skin,  an  ex- 
citement of  the  brain  cell  and  this  excitement  is  ac- 


140  PSYCHOTHERAPY 

companied  by  a  sensation ;  and  no  one  fancies  that  the 
appearance  of  this  sensation  is  dependent  upon  a 
special  disposition  for  it  on  the  mental  side.  No 
one  fancies  it,  because  it  is  evident  that  such  a  hypoth- 
esis again  would  be  entirely  useless.  If  every  new 
perception  needed  such  a  special  mental  disposition, 
we  should  have  to  presuppose  dispositions  for  every- 
thing which  possibly  can  come  into  our  surroundings. 
Every  smell,  every  word,  every  face  which  comes 
anew  to  us  would  need  its  special  ready-made  disposi- 
tion. In  other  words,  our  mind  would  contain  the 
disposition  for  every  possible  idea  and  that  would 
mean  that  these  dispositions  would  be  in  no  way 
helps  for  explanation.  If  the  disposition  exists  for 
everything,  no  one  particular  thing  can  be  explained 
by  the  existence  of  that  disposition.  Again  we  should 
have  to  rely  entirely  upon  the  physiological  brain 
excitement  for  explaining  that  this  word  or  that 
word  is  perceived  by  our  mind.  But  if  the  brain 
excitement  alone  is  sufficient  to  explain  the  new  per- 
ception in  the  mind,  then  no  reason  can  be  found  why 
the  renewed  brain  excitement  would  not  be  sufficient 
to  renew  the  mental  experience.  Thus  there  is  no- 
where room  for  mental  dispositions  below  the  level 
of  consciousness. 

Thirdly,  what  could  we  really  mean  by  such  men- 
tal dispositions?  A  physiological  disposition  for  a 
physiological  action  is  certainly  not  the  action  itself. 
The  finger  movement  in  piano  playing  finds  only  a 
disposition  in  my  brain  centers,  in  case  I  am  trained; 
the  movement  itself  does  not  last.  But  the  dis- 


THE  SUBCONSCIOUS  141 

position  is  at  least  itself  a  change  in  the  physical 
world.  The  molecules  are  somehow  differently 
placed,  the  disposition  has  thus  as  much  objective 
existence  as  the  resulting  movement.  Nothing  at  all 
similar  can  be  imagined  in  the  sphere  of  psychical 
contents.  Such  mental  dispositions  would  have  to 
exist  entirely  outside  the  world  of  concrete  mental 
experiences  and,  if  we  scrutinize  carefully,  we  soon 
discover  that  such  theories  are  only  lingering  reminis- 
cences of  the  purposive  view  of  life,  and  do  not  fit  at 
all  into  the  causal  one.  If  we  take  the  purposive 
attitude,  then  every  idea  and  every  will  contains  in- 
deed all  that  its  meaning  involves  and  everything 
which  we  can  logically  develop  out  of  it  is  by  inten- 
tion contained  in  it.  All  mathematical  calculations 
are  then  contained  in  the  thought  of  figures  and  forms, 
but  they  are  contained  there  only  by  intention,  they 
are  logically  inclosed;  psychologically  the  conscious- 
ness of  the  figures  and  forms  does  not  contain  any 
disposition  for  the  development  of  mathematical  sys- 
tems. We  indeed  have  no  right  to  throw  into  a 
psychological  subconsciousness  all  that  which  is  not 
present  but  involved  by  intention  in  the  ideas  and 
volitions  of  our  purposive  life. 

If  thus  the  memory  idea  is  linked  with  the  past  ex- 
perience entirely  by  the  lasting  physiological  change 
in  the  brain,  we  have  no  reason  to  alter  the  prin- 
ciple, when  we  meet  the  memory  processes  of  the 
hypnotized  person  or  the  hysteric.  It  is  true  their 
memory  may  bring  to  light  earlier  experiences  which 
are  entirely  forgotten  by  the  conscious  personality,  but 


PSYCHOTHERAPY 

that  ought  to  mean,  of  course,  only  that  nerve  paths 
have  become  accessible  in  which  the  propagation  of 
the  excitement  was  blocked  up  before.  That  does  not 
bring  us  nearer  to  the  demand  for  a  subconscious 
mental  memory.  The  threshold  of  excitability 
changes  under  most  various  conditions.  Cells  which 
respond  easily  in  certain  states  may  need  the  strong- 
est stimulation  in  others.  The  brain  cells  which  are 
too  easily  excited  perhaps  in  maniacal  exultation 
would  respond  too  slowly  in  a  melancholic  depression. 
Hypnotism,  too,  by  closing  the  opposite  channels  and 
opening  wide  the  channels  for  the  suggested  discharge, 
may  stir  up  excitements  for  which  the  disposition 
may  have  lingered  since  the  days  of  childhood  and 
yet  which  would  not  have  been  excited  by  the  normal 
play  of  the  neurons.  Quite  secondary  remains  the 
question  of  how  these  reproduced  images  finally  ap- 
pear in  consciousness,  that  is,  whether  they  appear 
with  reference  to  earlier  happenings  and  are  thus 
felt  as  remembrances,  or  whether  they  enter  as  inde- 
pendent imaginations,  or  whether  they  finally,  under 
special  conditions,  take  the  character  of  real,  new 
perceptions.  The  latter  case  is  well-known  in  crys- 
tal-gazing, where  long-forgotten  memory  ideas  pro- 
ject themselves  into  the  visual  field  like  hallucinations. 
But  for  the  theory  of  the  subconscious,  even  these  un- 
canny crystal  visions  do  not  mean  more  than  the 
simplest  awakening  of  the  experience  of  a  landscape 
image  of  yesterday. 

We  turn  to  a  second  group  of  facts  and  again  we 
have  no  fault  to  find  with  the  observation  of  the  facts, 


THE  SUBCONSCIOUS  143 

even  of  the  most  surprising  and  exceptional  ones. 
Our  objection  refers  to  the  interpretation  of  them. 
This  second  group  contains  the  active  results  of  such 
physiological  nervous  dispositions.  In  the  first  group, 
the  dispositions  come  in  question  only  as  conditions  for 
a  new  excitement  which  was  accompanied  by  mental 
experience.  In  this  second  group,  the  dispositions  are 
causes  for  other  physiological  processes  which  either 
lead  to  actions  or  to  influences  on  other  mental  proc- 
esses. The  dispositions  are  here  working  like  the 
setting  of  switches  which  turn  the  nervous  process  into 
special  tracks.  In  the  simple  cases,  of  course  no  one 
doubts  that  a  purely  physiological  basis  is  involved. 
The  decapitated  frog  rubs  its  skin  where  it  is  touched 
with  a  drop  of  muriatic  acid  in  a  way  which  is  ordi- 
narily referred  to  the  trained  apparatus  of  his  spinal 
cord,  as  no  brain  is  left,  and  the  usefulness  of  the  ac- 
tion and  its  adjustment  is  very  well  understood  as  the 
result  of  the  connecting  paths  in  the  nervous  system. 
From  such  simple  adjustment  of  reactions  of  the 
spinal  cord,  we  come  step  by  step  to  the  more  com- 
plex activities  of  the  subcortical  brain  centers,  and 
finally  to  those  which  are  evidently  only  short-cuts  of 
the  higher  brain  processes.  That  we  react  at  every 
change  of  position  with  the  right  movements  to  keep 
our  bodily  balance,  that  we  walk  without  thinking  of 
our  steps,  that  we  speak  without  giving  conscious  im- 
pulse for  the  various  speech  movements,  that  we 
write  without  being  aware  of  the  motor  activity 
which  we  had  to  learn  slowly,  that  we  play  the  piano 
without  thinking  of  the  special  impulses  of  the  hands, 


144  PSYCHOTHERAPY 

that  we  select  the  words  of  a  hasty  speech,  if  we 
have  its  aim  in  mind,  without  consciously  selecting 
the  appropriate  words — all  that  is  by  continuous 
transitions  connected  with  those  simplest  automatic 
reactions.  And  from  here  again,  we  are  led  over 
gradually  perhaps  to  the  automatic  writings  of  the 
hysteric  who  writes  complex  messages  without  having 
any  idea  of  their  content  in  consciousness.  It  is  in 
such  cases  certainly  a  symptom  of  disease  that  the 
activity  of  these  lower  brain  centers  can  go  over  into 
the  motor  impulse  of  writing  without  producing  sec- 
ondary effects  in  the  highest  conscious  brain  centers; 
it  is  hysterical.  But  that  the  message  of  the  pencil 
can  be  brought  about  by  such  operation  of  lower 
brain  centers,  or  at  least  with  imperfect  cooperation 
of  the  higher  brain  centers,  is  certainly  entirely  within 
the  limits  of  the  same  physiological  explanation. 

On  the  other  hand,  nothing  is  changed  in  the 
theoretic  principles  of  the  case  if  the  effect  of  these 
automatic  processes  in  the  nervous  system  is  not  an 
external  muscle  action  at  first,  but  an  influence  on 
other  brain  centers  which  may  furnish  the  conscious- 
ness with  new  contents.  We  try  to  remember  a  name, 
that  is,  a  large  number  of  neuron  processes  are  setting 
in  which  normally  lead  to  the  excitement  of  that  par- 
ticular process  which  furnishes  us  the  memory  image 
of  the  name.  But  those  brain  cells  may  not  respond, 
the  channels  may  be  blocked  somehow  or  the  excita- 
bility of  those  cells  may  be  lowered.  Now  new  ex- 
citements engage  our  psychophysical  system.  We 
are  thinking  of  other  problems.  In  the  meantime,  by 


THE  SUBCONSCIOUS  145 

the  new  equilibrium  in  the  brain  the  blockade  in 
these  first  paths  may  slowly  disappear  or  the  threshold 
of  excitability  may  be  changed.  The  physiological 
excitement  may  now  be  carried  effectively  into  those 
tracts.  The  cell  response  sets  in  and  suddenly  the 
name  comes  to  our  mind.  This  purely  physiological 
operation  in  our  brain  paths  must  thus  have  exactly 
the  same  result  which  it  would  have  had,  if  more 
parts  of  the  process  had  been  accompanied  by  con- 
scious experience.  And  again  from  mere  remember- 
ing a  forgotten  name,  we  come  by  slow  steps  to  the 
solution  of  a  problem,  to  the  invention,  and  finally  to 
the  creation  of  the  genius. 

Superficiality  of  thought  is  easily  inclined  to  ob- 
ject to  such  a  physiological  interpretation  and  perhaps 
to  denounce  it  pathetically  as  a  crude  materialism 
which  lowers  the  dignity  of  mental  work.  Nothing 
shows  more  clearly  the  confusion  between  a  purposive 
and  causal  view  of  the  mind.yin  the  purposive  view 
of  our  real  life,  only  our  wjjl  and  our  personality  have 
a  meaning  and  can  be  related  to  the  ideas  and  higher 
aims.  Nature  is  there  nothing  but  the  dead  material 
which  is  the  tool  of  our  will  and  which  has  to  be 
mastered  by  the  personality.  In  that  world  alone  lie 
our  duty  and  our  morality.  But  as  soon  as  we  have 
gone  over  to  the  causal  aspect  of  our  life  and  have 
taken  the  point  of  view  of  the  psychologist,  making 
our  inner  life  a  series  of  contents  of  consciousness,  of 
psychical  phenomena,  we  have  transformed  our  inner 
experience  in  such  a  way  that  it  has  become  itself 
nothing  but  nature. 


i46  PSYCHOTHERAPY 

It  is  mental  nature,  nature  of  psychical  stuff,  but 
each  part  of  it  is  nothing  but  a  mental  element,  a  men- 
tal atom  without  any  meaning  and  without  any  value; 
nothing  but  a  link  in  the  chain,  nothing  but  a  factor 
in  the  explanation  of  the  whole,  nothing  to  which  any 
ethical  or  aesthetic  or  logical  or  religious  significance 
can  any  longer  be  attached.  The  psychical  sensations 
and  the  physical  atoms  are  equally  material  for  natu- 
ralistic explanation.  To  understand  causally  a  certain 
effect,  for  instance  the  creation  of  a  work  of  art,  of 
a  discovery  or  a  thought  or  a  deed  as  the  product  of 
psychical  processes,  is  thus  in  no  way  more  dignified  or 
more  valuable  than  to  understand  it  as  the  product  of 
physiological  brain  processes.  The  one  is  not  more 
dignified  than  the  other  because  both  alike  have  noth- 
ing whatever  to  do  with  dignity.  Both  alike  are  the 
necessary  results  of  the  foregoing  processes,  and  to 
attach  a  kind  of  sentimental  preference  to  the  ex- 
planation through  conscious  factors  is  nothing  but 
a  confused  reminiscence  again  of  the  entirely  different 
purposive  view  of  life.  And  surely  nothing  is  gained 
for  the  higher  values  of  life  if  this  confusion  sets  in, 
because  if  the  popular  mind  becomes  unable  to  dis- 
criminate between  the  secondary,  causal,  artificial 
aspect  of  science  and  the  primary,  purposive  aspect  of 
life,  the  opposite  effect  lies  still  nearer:  the  values  of 
the  real  life  suffer  and  are  crowded  out  by  the  knowl- 
edge of  the  scientific  facts.  Man's  moral  freedom 
is  then  wrongly  brought  in  question,  as  soon  as  it  is 
learned  that  every  action  is  the  product  of  brain 
processes.  Life  and  science  alike  will  gain  the 


THE  SUBCONSCIOUS  147 

more,  the  more  clearly  the  purposive  and  the  causal 
point  of  view  are  separated  and  the  more  it  is 
understood  that  this  causal  aspect  itself  is  de- 
manded by  certain  purposes  of  life.  The  oratory 
of  those  who  denounce  the  physiological  theories 
as  lacking  idealism  in  reality  undermines  true  moral 
philosophy.  There  is  no  idealism  which  can  really 
flourish  merely  by  ignoring  the  progress  of  science 
and  confusing  the  issues.  The  true  values  of  the 
higher  life  cannot  be  safely  protected  by  that  thought" 
less  idealism  which  draws  its  life  from  vagueness  and 
which  therefore  has  to  be  afraid  of  every  new  discov- 
ery in  scientific  psychology.  Our  real  ideals  do  not 
lie  at  all  in  the  sphere  in  which  the  problem  of  causally 
explaining  the  psychological  phenomena  arises. 

Our  conscious  experiences  are  thus  indeed  not  only 
here  and  there,  but  usually  the  products  of  chains  of 
processes  which  go  on  entirely  on  the  physiological 
side.  We  have  no  reason  at  all  to  seek  for  those 
preceding  actions  any  mental  accompaniment  outside 
of  consciousness,  that  means,  any  subconscious  mental 
states.  Then,  of  course,  this  physiological  explana- 
tion also  covers  entirely  those  after-effects  of  earlier 
experiences,  especially  emotional  experiences,  which 
the  physician  nowadays  likes  to  call  subconscious 
"  complexes."  We  shall  see  what  an  important  role 
belongs  to  these  facts,  especially  in  the  treatment  of 
hysteria  and  psychasthenia,  but  the  interpretation 
again  ought  to  avoid  all  playing  with  the  conception 
of  the  subconscious.  Emotional  experiences  may  pro- 
duce there  some  strong  stable  dispositions  in  the  brain 


i48  PSYCHOTHERAPY 

system  which  become  mischievous  in  reenforcing 
or  inhibiting  certain  thoughts  and  actions  without 
awakening  directly  conscious  experiences.  The  whole 
psychological  switch  system  may  have  been  brought 
into  disorder  by  such  abnormal  setting  of  certain 
parts,  but  the  connection  of  each  resulting  accident 
with  the  primary  emotional  disturbances  does  not  con- 
tradict the  fact  that  all  the  causes  lie  entirely  in  dis- 
turbances of  the  central  paths.  It  is  a  change  in  the 
neurons  and  their  connections.  To  discover  it  we  may 
have  to  go  back  to  early  conscious  experiences,  but 
in  the  process  itself  there  is  no  mental  factor,  and 
therefore  no  subconscious  emotion  is  responsible  for 
the  mischief  carried  out. 

Both  groups  of  facts  which  we  have  studied  so 
far,  have  dealt  with  processes  which  were  indeed  not 
conscious  but  which  we  had  no  right  to  call  subcon- 
scious inasmuch  as  they  contained  no  mental  process 
at  all  but  only  physiological  dispositions  and  actions. 
We  turn  finally  to  the  other  smaller  and  more  ab- 
normal group  of  so-called  subconscious  facts  in  which 
the  facts  are  mental  indeed  and  not  only  physiological, 
but  not  at  all  outside  of  consciousness  and  thus  again 
not  subconscious.  A  conscious  fact  may  easily  sug- 
gest the  appeal  to  subconscious  theories  to  those  who 
have  accepted  such  theories  for  other  reasons.  There 
are,  for  instance,  plenty  of  mental  experiences  which 
we  do  not  notice  or  which  we  do  not  recognize.  Yet 
if  we  find  later  that  they  must  have  influenced  our 
mind,  we  are  easily  inclined  to  refer  them  to  sub- 
conscious activity.  But  it  is  evident  that  to  be  con- 


THE  SUBCONSCIOUS  149 

tent  of  consciousness  means  not  at  all  necessarily  to 
be  object  of  attention  or  object  of  recognition. 
Awareness  does  not  involve  interest.  If  I  hear  a 
musical  sound,  I  may  not  recognize  at  all  the  over- 
tones which  are  contained  in  it.  As  soon  as  I  take 
resonators  and  by  them  reinforce  the  loudness  of 
those  overtones,  they  become  vivid  for  me  and  I  can 
now  notice  them  well  even  when  the  resonators  are 
removed.  I' surely  was  aware  of  them,  that  is,  had 
them  in  consciousness  all  the  time  but  there  were  no 
contrast  feelings  and  no  associations  in  conscious- 
ness which  gave  them  sufficient  clearness  to  attract 
attention. 

In  this  way  I  may  be  again  led  by  gradual  stages  to 
more  and  more  complex  experiences.  I  may  overlook 
and  yet  include  within  my  content  of  consciousness 
most  various  parts  of  my  surroundings;  and  yet  the 
neglected  is  not  less  in  consciousness  itself  than  the 
attended.  Much  that  figures  in  literature  as  sub- 
conscious means  indeed  nothing  else  but  the  unat- 
tended. But  it  belongs  to  the  elements  of  psycholog- 
ical analysis  to  recognize  that  the  full  content  of  con-  , 
sciousness  is  always  larger  than  the  narrow  field  of 
attention.  This  narrow  field  on  the  other  hand  has 
certainly  no  sharp  demarcation  line.  There  is  a 
steady  shading  off  from  the  most  vivid  to  the  least 
vivid.  We  cannot  grasp  those  least  vivid  contents 
of  consciousness,  we  cannot  fixate  them  as  such,  be- 
cause as  soon  as  we  try  to  hold  them,  they  move  from 
the  periphery  of  the  content  into  its  center  and  be- 
come themselves  vivid  and  clear.  But  as  we  are 


150  PSYCHOTHERAPY 

surely  aware  of  different  degrees  of  clearness  and 
vividness  in  our  central  mass  of  contents,  we  have  no 
difficulty  in  acknowledging  the  existence  of  still  lower 
degrees  of  vividness  in  those  elements  which  are 
blending  and  fusing  into  a  general  background  of 
conscious  experiences.  Nothing  stands  out  there, 
nothing  can  be  discriminated  in  its  detail.  That  back- 
ground is  not  even  made  up  of  whole  ideas  and  whole 
memories  and  whole  emotions  and  feelings  and  judg- 
ments and  volitions,  but  of  loose  fragments;  half 
ideas  and  quarter  ideas,  atoms  of  feelings  and  incipi- 
ent impulses  and  bits  of  memory  images  are  always 
mixed  in  that  half-dark  background.  And  yet  it  is 
by  principle  not  less  in  consciousness,  and  conscious- 
ness itself  is  not  different  for  these  contents.  It  is  not 
half-clear  consciousness,  not  a  lower  degree  of  aware- 
ness, only  the  objects  of  awareness  are  crumbled  and 
fading. 

Whether  these  background  objects  really  exist  can 
only  be  made  out  by  studying  carefully  the  changes 
which  result  under  different  conditions,  the  influences 
I  which  those  loose  parts  have  on  the  structure  of  the 
whole,  and  the  effect  of  their  complete  disappearance. 
I  may  never  really  notice  a  little  thing  in  my  room  and 
yet  may  be  aware  that  it  has  been  taken  away.  The 
I  visual  image  of  it  was  an  element  of  my  mental  back- 
ground, when  I  was  sitting  at  my  desk,  but  it  never 
before  moved  to  the  center  of  my  conscious  content. 
But  this  center  itself  is  also  constantly  changing. 
Sometimes  the  one,  sometimes  the  other  idea  may 
enter  into  it,  but  in  this  alternation  that  which  is  not 


THE  SUBCONSCIOUS  151 

in  the  focus  either  remains  in  consciousness  unat- 
tended or  when  it  disappears  from  it  it  loses  its  mental 
character  altogether.  If  I  attend  a  tiresome  lecture 
while  my  mind  is  engaged  with  a  practical  problem 
of  my  own  life,  there  may  be  a  steady  rivalry  between 
the  words  which  come  with  the  force  of  outer  stimulus 
to  my  brain  and  make  me  listen  and  my  inner  diffi- 
culties which  claim  my  attention.  I  listen  for  a  while, 
and  then  suddenly,  without  noticing  it,  my  own 
thoughts  may  have  taken  the  center  of  the  stage  and 
again  without  sudden  interruption  a  word  may  catch 
my  attention.  While  I  was  thinking  of  my  own 
problem  the  sounds  of  the  lecturer  were  really  out- 
side of  my  field  of  attention,  yet  some  remark  now 
pushes  itself  again  into  the  center.  That  does  not 
mean  that  a  subconscious  mind  is  listening  while  my 
lucid  mind  was  thinking,  but  it  does  mean  that  those 
words  were  unattended  and  remained  in  the  periphery 
of  the  field  of  consciousness.  But  when  some  of  the 
sentences  stirred  up  in  that  peripheral  field  some  im- 
portant associations,  they  were  strong  enough  to  pro- 
duce a  new  motor  reaction  by  which  the  mental 
equilibrium  became  changed  again  and  by  which  the 
lecturer  overwhelmed  my  private  thoughts.  Yet  even 
this  state  of  mind,  without  any  break,  can  go  over 
into  an  absolutely  physiological  process.  I  may  for 
a  while  really  inhibit  the  lecturer's  voice  completely 
and  remain  in  the  thoughts  of  my  own  imagination. 
After  a  minute  or  two,  the  resistance  against  the 
acoustical  stimulus  will  certainly  be  broken  and  the 
sound  will  again  enter  into  my  consciousness,  but  in 


1 52  PSYCHOTHERAPY 

that  interval  there  was  no  subconscious  and  not  even 
any  unattended  mental  function ;  there  was  no  mental 
process  at  all.  The  sound  reached  my  brain  but  as 
the  motor  setting  was  adverse,  the  sounds  did  not 
bring  about  that  highest  act  of  physiological  trans- 
mission which  is  accompanied  by  mental  contents. 
Thus  it  became  entirely  physiological.  Yet  of  course 
every  word  reached  my  brain  and  left  traces  there. 
If  I  were  hypnotized  after  the  lecture  and  thus  the 
threshold  for  the  real  awakening  of  brain  excitements 
lowered,  it  might  not  be  impossible  that  some  of  the 
thoughts  of  the  lecturer  which  did  not  enter  my  con- 
sciousness at  all,  are  now  afterwards  in  the  hypnotic 
state  stirred  up  in  me.  Yet  even  that  would  not  indi- 
cate that  they  had  become  mental  and  thus  subcon- 
scious at  the  time  of  the  lecture. 

The  so-called  subconscious,  which  in  reality  is  fully 
in  consciousness  but  only  unnoticed,  easily  shades 
over  into  that  unconscious  which  is  also  in  conscious- 
ness but  dissociated  from  the  idea  of  the  own  per- 
sonality and  thus  somewhat  split  off  from  the  inter- 
connected mass  of  conscious  contents.  Wherever  we 
meet  such  phenomena,  we  are  in  the  field  of  the  ab- 
normal. The  normal  mental  life  is  characterized  by 
the  connectedness  of  the  contents.  Yet  even  that 
holds  true,  of  course,  only  if  we  think  of  those  mental 
states  which  exist  at  one  and  the  same  instant  in  con- 
sciousness. As  soon  as  we  consider  the  succession  of 
mental  events,  we  cannot  doubt  that  even  normal  ex- 
perience shows  breaks,  lapses,  and  complete  annihila- 
tion of  that  which  a  moment  before  was  a  real  content 


THE  SUBCONSCIOUS  153 

in  our  consciousness.  We  may  have  looked  at  our 
watch  and  certainly  had  in  glancing  at  the  dial  a 
conscious  impression,  but  in  the  next  moment  we  no 
longer  know  how  late  it  is.  The  impression  did  not 
connect  itself  with  our  continuous  personal  experi- 
ence, that  is,  with  that  chief  group  of  our  conscious 
contents  which  we  associate  with  the  perception  of  our 
personality.  Under  abnormal  conditions  of  the  brain, 
larger  and  larger  parts  of  the  completely  conscious 
experience  may  thus  be  cut  off  from  the  continuity 
of  conscious  life.  But  to  be  in  consciousness,  and 
therefore  to  be  not-subconscious,  does  not  mean  to  be 
through  memory  ties  connected  with  the  idea  of  our 
own  personality. 

The  somnanbulist,  for  instance,  may  get  up  at  night 
time  and  write  a  letter,  then  go  to  bed  again  and  not 
know  anything  of  the  event  when  he  awakes  in  the 
morning.  We  have  no  reason  to  claim  that  he  had 
no  knowledge  of  the  letter  in  his  consciousness  when 
he  wrote  it.  It  is  exactly  the  same  consciousness  from 
a  psychological  standpoint  as  the  one  with  which  he 
wakes  up.  Only  that  special  content  has  in  an  abnor- 
mal way  entirely  disappeared,  has  not  left  a  possibility 
of  awakening  a  memory  image,  and  the  action  of  the 
personality  in  writing  has  thus  become  separated  and 
cut  off  from  the  connected  experiences  of  the  man. 
But  while  the  nocturnal  episode  may  be  entirely  for- 
gotten, it  was  not  less  in  consciousness  for  the  time 
being,  than  if  a  normal  man  should  leave  his  bed 
hastily  to  write  a  letter.  Moreover  under  abnormal 
conditions,  as  for  instance  in  severe  hysteric  cases, 


i54  PSYCHOTHERAPY 

those  dissociated  contents  may  form  large  clusters  of 
mental  experiences  in  the  midst  of  which  a  new  idea 
jjfthe  own  personality  may  develop.  Considering  that 
ihrough  such  disconnection  many  channels  of  dis- 
charge are  blocked,  while  others  are  abnormally 
opened,  it  seems  only  natural  that  the  idea  of  the  own 
acting  personality  becomes  greatly  changed.  Thus 
we  have  in  such  an  episode  a  new  second  personality 
which  may  be  strikingly  different  in  its  behavior  and 
in  its  power,  in  its  memories  and  in  its  desires,  from 
the  continuous  normal  one,  and  this  secondary  per- 
sonality may  now  develop  its  own  continuity  and  may 
arise  under  special  conditions  in  attacks  which  are 
connected  among  one  another  by  their  own  memory 
bonds. 

The  two  personalities  may  even  alternate  from  day 
to  day  and  the  normal  one  may  itself  become  patho- 
logically altered.  In  that  case  the  two  alternating 
personalities  would  both  be  different  from  the  original 
one.  But  again  we  have  even  in  such  most  complex 
and  exceptional  cases  only  an  alternation  in  the  con- 
tents, not  an  alternation  in  the  consciousness  itself. 
Different  ideas  of  the  own  personality  with  different 
associations  and  impulses  follow  each  other  in  con- 
sciousness and  the  abnormality  of  the  situation  lies 
in  the  lack  of  memory  connections  and  of  mutual  influ- 
ences, but  consciousness  remains  the  same  throughout. 
It  remains  the  same,  just  as  we  do  not  change  con- 
sciousness if  we  feel  ourselves  in  one  hour  as  members 
of  our  family,  in  the  next  hour  as  professional  work- 
ers in  our  office,  again  later  as  social  personalities  at 


THE  SUBCONSCIOUS  155 

a  party  or  as  citizens  at  a  political  meeting  or  as 
aesthetic  subjects  at  the  theater.  Each  time  we  are  to 
a  high  degree  a  different  personality,  the  idea  of  our 
self  is  each  time  determined  by  different  groups  of 
associations,  memories,  emotions,  and  impulses.  The 
differentiation  is  to  be  considered  as  normal  only  be- 
cause broad  memory  bridges  lead  over  from  one  to  the 
other.  The  connection  of  the  various  contents  with 
the  various  ideas  of  the  own  personality  constitutes 
thus  in  no  way  a  break  of  consciousness  itself  and 
relegates  no  one  content  into  a  subconscious  sphere. 
Finally  the  same  holds  true,  if  the  idea  of  the  per- 
sonality as  content  of  consciousness  in  the  patient  is 
split  into  two  simultaneous  groups,  of  which  each  one 
is  furnished  with  its  own  associations.  Yet  the  inter- 
pretation here  becomes  extremely  difficult  and  ar- 
bitrary. Take  the  case  that  a  patient  in  severe 
hysteria  at  our  request  writes  down  the  history  of  her 
life.  We  should  not  hesitate  to  say  that  she  is  doing 
it  consciously  but  now  we  begin  to  talk  with  her  and 
slowly  the  conversation  takes  her  attention  while  her 
pencil  is  continuing  to  write  down  the  connected  story 
of  her  youth.  Again  the  conversation  by  itself  gives 
the  impression  of  completely  conscious  behavior.  As 
both  functions  go  on  at  the  same  time,  the  person 
who  converses  does  not  know  what  the  person  who 
writes  is  writing,  and  the  writer  is  uninfluenced  by  the 
conversation.  Various  interpretations  are  possible. 
Indeed  we  might  think  that  by  such  double  setting  in 
the  pathological  brain  two  independent  groups  in 
the  content  of  consciousness  are  formed,  each  one 


156  PSYCHOTHERAPY 

fully  in  consciousness  and  yet  both  without  any  mutual 
influence  and  thus  without  mutual  knowledge.  In 
the  light  of  such  interpretation,  it  has  been  correctly 
proposed  to  speak  of  coconscious  processes,  rather 
than  subconscious.  Or  we  may  interpret  it  more  in 
harmony  with  the  ordinary  automatic  writing  or  with 
other  merely  physiological  reactions.  Then  we 
should  suppose  that  as  soon  as  the  conversation  sets 
in,  the  brain  centers  which  control  the  writing  move- 
ment work  through  channels  in  which  no  mental 
factors  are  involved.  One  of  the  two  characteristic 
reaction  systems  would  then  be  merely  physiological. 
We  saw  before  that  the  complexity  of  the  process  is  no 
argument  against  the  strictly  physiological  character 
of  the  event.  That  various  activities  can  coexist  in 
such  a  way  that  one  of  them  may  at  any  time  slide 
down  from  the  conscious  centers  to  the  merely  physi- 
cal ones,  we  all  know  by  daily  experience.  We  may 
go  home  through  the  streets  of  the  busy  town  en- 
gaged with  our  thoughts.  For  a  while  the  idea  of  our 
way  and  of  the  sidewalk  is  in  our  consciousness,  when 
suddenly  we  reach  our  house  and  notice  that  for  a 
long  while  we  have  no  longer  had  any  thought  at 
all  of  the  way.  We  were  absorbed  by  our  problems, 
and  the  motor  activity  of  walking  towards  our  goal 
was  going  on  entirely  in  the  physiological  sphere. 
But  whether  we  prefer  the  physiological  account  or 
insist  on  the  coconscious  phenomena,  in  either  case  is 
there  any  chance  for  the  subconscious  to  slip  in? 
That  a  content  of  consciousness  is  to  a  high  degree 
dissociated  or  that  the  idea  of  the  personality  is  split 


THE  SUBCONSCIOUS  157 

off  is  certainly  a  symptom  of  pathological  disturb- 
ance, but  it  has  nothing  to  do  with  the  constituting  of 
two  different  kinds  of  consciousness  or  with  breaking 
the  continuous  sameness  of  consciousness  itself.  The 
most  exceptional  and  most  uncanny  occurrences  of  the 
hospital  teach  after  all  the  same  which  our  daily  ex- 
perience ought  to  teach  us:  there  is  no  subconscious- 
ness. 


PART  II 

THE  PRACTICAL  WORK  OF  PSYCHO- 
THERAPY 

VII 
THE  FIELD  OF  PSYCHOTHERAPY 

WE  have  discussed  the  psychological  tools 
with  which  the  psychotherapist  has  to 
work  but  we  have  not  spoken  as  yet  of 
psychotherapy  itself.  All  that  we  have  studied  has 
been  by  way  of  preparation;  and  yet  the  right  prepa- 
ration is  almost  the  most  important  factor  for  the 
right  kind  of  work.  To  rush  into  psychotherapy  with 
hastily  gathered  conceptions  of  mental  life  may  be 
sometimes  successful  for  the  moment,  but  must  always 
be  ultimately  dangerous.  It  is  often  most  surprising 
what  a  haphazard  kind  of  psychology  is  accepted  as 
a  basis  for  psychotherapy  even  by  scientifically 
schooled  physicians  who  would  never  believe  that  com- 
mon sense  would  be  sufficient  to  settle  the  problems 
of  anatomy  and  physiology;  as  soon  as  the  mind  is  in 
question,  no  serious  study  seems  needed.  Can  we  be 
surprised  then  that  in  the  amateur  medicine  of  the 
country  within  and  without  the  church  any  fanciful 

158 


THE  FIELD  OF  PSYCHOTHERAPY    159 

idea  of  mental  life  may  flourish?  If  we  are  to 
recognize  the  rights  and  wrongs  of  psychotherapy  in 
a  scientific  spirit,  a  sober  analysis  of  the  mental  facts 
involved  was  indeed  at  the  very  first  most  essential. 
Now  we  can  easily  draw  the  conclusions  from  our 
findings. 

We  recognized  from  the  start  the  fundamental  dif- 
ference between  two  different  attitudes  which  we  can 
take  towards  the  inner  life  of  any  personality,  the 
purposive  view  and  the  causal.  We  recognized  the 
sphere  to  which  each  belongs  and  we  saw  that  all 
medical  treatment  demands  the  causal  view,  thus 
dealing  with  inner  life  as  part  of  the  causal  chain  of 
events.  Each  inner  experience  became  therefore  a 
series  of  so-called  contents  of  consciousness.  These 
contents  can  be  described  and  must  be  analyzed  into 
their  elements.  The  basis  of  psychotherapy  is  there- 
fore an  analytic  psychology  which  conceives  the  inner 
experience  as  a  combination  of  psychical  elements. 

But  the  final  aim  was  the  causal  connection.  The 
appearance  and  disappearance  of  those  millions  of 
elements  and  their  connection  had  to  be  explained. 
We  recognized  that  such  an  explanation  of  the  con- 
tents of  consciousness  was  possible  only  through  the 
connections  between  the  accompanying  brain  proc- 
esses. Every  psychical  change  had  to  be  conceived 
as  parallel  to  a  physiological  change..  The  psychol- 
~bgy  which  is  to  be  the  basis  of  psychotherapy  had  to 
be  therefore  a  physiological  psychology. 

We  recognized  that  these  psychophysiological  proc- 
esses were  processes  of  transmission  between  impres- 


i 


1 60  PSYCHOTHERAPY 

sions  and  expressions,  that  is,  between  incoming  nerv- 
ous currents  and  outgoing  nervous  currents,  between 
stimuli  and  reactions.  Thus  we  have  no  central  proc- 
ess which  is  not  influenced  by  the  surroundings  and 
which  is  not  at  the  same  time  the  starting  point  of  an 
action.  We  have  normal  health  of  the  personality 
as  long  as  there  is  a  complete  equilibrium  in  the  func- 
tions of  the  organism  which  adjusts  the  activities  to 
the  surroundings.  Every  abnormality  is  a  disturb- 
ance of  this  equilibrium.  A  psychology  which  is  the 
basis  of  psychotherapy  thus  conceives  every  mental 
process  in  relation  to  both  the  ideas  and  the  actions; 
it  avoids  all  one-sidedness  by  which  the  mind  is  cut  off 
either  from  its  resources  or  from  its  effects.  The 
relations  to  the  impressions  are  usually  the  less 
neglected:  and  we  must  the  more  emphasize  the  fact 
that  the  psychology  needed  for  psychotherapy  knows 
no  mental  fact  which  does  not  start  an  action  and  that 
every  change  in  the  system  of  actions  involves  a 
change  in  the  central  experience.  Wherever  this 
equilibrium  of  adjusted  functions  is  disturbed,  some 
therapy  of  the  physician  has  to  set  in:  whether  psy- 
chotherapy is  in  order  depends  upon  the  special  con- 
ditions. 

We  have  recognized  that  there  are  no  mental  facts 
outside  of  those  which  are  in  consciousness  and  that 
from  a  psychological  point  of  view  consciousness 
itself  does  not  have  different  degrees  and  different 
levels,  that  all  varieties  of  experience  refer  thus  only 
to  the  special  content  and  its  organization.  There  is 
thus  no  subconscious.  On  the  other  hand,  we  saw 


THE  FIELD  OF  PSYCHOTHERAPY  161 

that  there  is  no  conscious  experience  which  is  not 
based  on  a  bodily  brain  process.  By  these  two  funda- 
mental facts  of  scientific  psychology,  every  possible 
psychotherapy  gets  from  the  start  its  clear  middle 
way  between  two  extreme  views  which  are  popular 
today.  The  one  school  nowadays  lives  from  the 
contrast  between  consciousness  and  subconsciousness 
and  makes  all  psychotherapy  work  with  and  through 
and  in  the  subconscious.  The  other  school  creates  a 
complete  antithesis  between  mind  and  body  and 
makes  psychotherapy  a  kind  of  triumph  of  the  mind 
over  the  body.  Practically  every  popular  treatise  on 
psychotherapeutic  subjects  in  recent  years  belongs  to 
the  one  or  the  other  group ;  and  yet  both  are  funda- 
mentally wrong.  And  while,  of  course,  this  mistake 
is  one  of  theoretical  interpretation,  it  evidently  has 
its  practical  consequences.  The  fantastic  position  al- 
lowed to  a  subconscious  mind  easily  gives  to  the  doc- 
trine a  religious  or  even  a  mystical  turn  and  the  arti- 
ficial separation  between  the  energies  of  the  mind  and 
those  of  the  body  leads  easily  to  a  moral  sermon. 
Whether  this  amalgamation  of  medicine  with  religion 
or  with  morality  may  not  be  finally  dangerous  to  true 
morality  and  true  religion  is  a  question  which  will  in- 
terest us  much  later.  Here  we  only  have  to  ask 
whether  it  is  not  harmful  to  the  interests  of  the  pa- 
tient and  thus  to  the  rights  of  medicine,  and  indeed 
that  must  be  evident  here  at  the  very  threshold. 
Both  schools  must  have  the  tendency  to  extend  psy- 
chotherapy at  the  expense  of  bodily  therapy  and  to 
narrow  down  psychotherapy  itself  to  a  therapy  by 


1 62  PSYCHOTHERAPY 

appeals  which  in  the  one  case  are  suggestions  to  the 
subconscious  and  in  the  other  case  persuasions  and 
encouragements  to  the  conscious  will.  As  soon  as 
w£  have  overcome  the  prejudices  of  those  two  rival 
schools  and  have  recognized  that  both  are  wrong, 
that  there  is  no  ^subconscious  and  that  there  is  no  psv- 
chological  fact  which  isjiot  at  the  same  time  a  physio- 
logical one,  we  see  at  once  that  this  common  pro- 
cedure of  both  schools  is  unjustified  and  dangerous. 
Mental  therapy  and  physical  therapy  ought  to  be 
most  intimately  connected  parts  of  the  same  thera- 
peutic effort  and  mental  therapy  includes  by  far  more 
than  mere  suggestions  and  appeals.  All  that  in- 
volves of  course  that  its  systematic  application  be- 
longs in  the  hands  of  the  well-trained  physician  and 
of  nobody  else,  but  on  the  other  hand,  it  involves  that 
every  physician  ought  to  be  well  schooled  in  psychol- 
ogy- 

As  soon  as  a  disturbance  to  be  cured  is  considered 

as  a  lack  of  equilibrium  in  psychophysical  functions, 
every  mental  influence,  every  suggestion  and  appeal 
becomes  itself  an  excitement  or  an  inhibition  of  nerve 
cells.  The  sharp  demarcation  line  between  a  psychical 
agency  and  a  physical  one  disappears  altogether; 
the  spoken  word  is  then  considered  as  physical  air- 
waves which  stimulate  certain  brain  centers  and  in 
the  given  paths  this  stimulation  is  carried  to  hundreds 
of  thousands  of  neurons.  The  protracted  warm  bath 
or  the  cold  douche  influences,  too,  large  brain  parts 
by  changing  the  blood  circulation  which  controls  the 
activity  of  those  neurons ;  or  the  bromides  absorbed  in 


THE  FIELD  OF  PSYCHOTHERAPY  163 

the  digestive  apparatus,  or  the  morphine  injected, 
also  reach  the  neurons  and  again  have  a  different 
kind  of  influence  on  them,  and  the  electric  current 
may  stimulate  the  nervous  system  in  still  a  different 
way.  It  may  be,  and  under  many  conditions  cer- 
tainly is,  essential  to  influence  the  brain  cells  just  in 
that  particular  way  which  results  from  the  spoken 
word,  but  there  too  the  causal  influence  remains  a 
function  of  the  physical  effect  and  thus  by  principle 
there  is  no  sharp  separation  from  other  physical 
means.  Thus  to  believe  in  psychotherapy  ought 
never  to  mean  that  we  have  a  right  to  make  light  of 
the  other  means  which,  as  experience  shows,  may  help 
towards  the  treatment  of  disturbances  in  the  central 
equilibrium.  Suggestions  and  bromides  together 
may  secure  an  effect  which  neither  of  them  alone 
will  bring  about.  It  is  most  unfortunate  that  not 
without  some  guilt  on  the  part  of  the  physicians  them- 
selves, the  large  public  has  begun  to  believe  that 
orthodox  psychotherapy  has  to  mean  a  rejection  of 
drugs  and  a  contempt  for  the  doctors  who  prescribe 
them. 

Of  course  a  discussion  of  psychotherapy  cannot 
enter  into  the  study  of  these  physical  agencies  of 
treatment,  but  at  the  threshold,  we  have  to  insist  that 
there  exists  no  opposition  between  psychophysiolog- 
ical  and  physiological  means  of  influencing  the  brain. 
It  may  be  true  that  drugs  and  baths  and  electricity 
have  no  influence  on  the  subconscious,  but  the  trouble 
is  not  that  the  drugs  are  inefficient  but  that  they  can- 
not influence  what  does  not  exist.  In  the  same  way 


1 64  PSYCHOTHERAPY 

disappears  now  that  new  boundary  line  for  psycho- 
therapy which  wants  to  limit  it  to  mere  suggestion 
and  appeal.  If  psychotherapy  employs  all  the  means 
by  which  we  can  influence  mental  states  in  the  interest 
of  the  health  of  the  personality,  we  have  no  reason  to 
confine  it  either  to  a  persuasion  of  the  subconscious 
through  suggestion  and  hypnotism  or  a  persuasion  of 
the  conscious,  in  which  it  works  as  a  moral  appeal. 
Suggestion  and  hypnotism  certainly  must  play  a  large 
part  in  psychotherapy  and  that  part  does  not  become 
smaller  by  the  fact  that  we  reject  the  subconscious  in- 
terpretation of  them  and  consider  them  entirely  as 
psychophysical  processes.  And  in  the  same  way  un- 
doubtedly we  have  to  acknowledge  the  psychophysio- 
logical  effect  of  persuasion  and  of  the  appeals  to  the 
conscious  intellect  and  will.  But  for  us  as  psycho- 
therapists all  those  factors  have  no  moral  value  but 
only  a  therapeutic  one,  and  thus  stand  in  line  with 
any  other  influence  that  may  help,  even  though  from 
a  purposive  point  of  view  it  stands  on  a  much  lower 
level.  A  mere  mental  distraction  by  enjoyment  and 
play  and  sport,  an  aesthetic  influence  through  art,  a 
mere  stimulus  to  automatic  imitation,  an  enforced 
mental  rest,  an  involuntary  discharge  of  sup- 
pressed ideas,  and  many  similar  schemes  and  even 
tricks  of  the  mental  physician  belong  with  the  same 
right  to  psychotherapy. 

It  is  really  doubtful  whether  the  moral  and  reli- 
gious appeals  are  always  helpful  and  not  sometimes 
or  often  even  dangerous  for  the  health  of  the  indi- 
vidual; and  it  is  not  doubtful  that  morally  and  reli- 


THE  FIELD  OF  PSYCHOTHERAPY  165 

giously  indifferent  mental  influences  are  often  of  the 
highest  curative  value.  The  more  we  abstract  from 
everything  which  suggests  either  the  mysticism  of  the 
subconscious  or  the  moral  issues  of  a  mind  which  is 
independent  of  the  body,  the  more  we  shall  be  able 
to  answer  the  question  as  to  the  means  by  which 
health  can  be  restored.  This  question  is  neither  a 
moral  nor  a  philosophical  one  but  strictly  one  of  ex- 
perience. In  this  connection,  we  must  remember 
that  we  also  have  had  to  give  up  the  artificial  de- 
marcation line  between  organic  and  functional  dis- 
eases. We  recognized  that  every  so-called  func- 
tional disease  has  its  organic  basis  too,  and  that  it  is 
entirely  secondary  whether  we  are  able  to  find  visible 
traces  of  the  organic  disturbance.  We  had  to  ac- 
knowledge, to  be  sure,  the  difference  between  repa- 
rable and  irreparable  disturbances,  but  such  group- 
ing expresses  only  in  another  form  the  fact  that  ex- 
perience alone  can  show  whether  the  methods  of 
treatment  which  we  know  so  far  will  be  successful  or 
not.  Not  a  few  disturbances  of  the  equilibrium 
which  appeared  irreparable  to  an  earlier  time  yield  to 
the  treatment  of  to-day,  and  no  one  can  determine 
whether  much  which  appears  irreparable  today  may 
not  be  accessible  either  to  psychotherapeutic  or  to 
physical  therapeutic  means  tomorrow.  If  we  were 
carelessly  to  identify  the  reparable  troubles  with 
those  which  we  cannot  recognize  visibly,  we  should 
be  at  a  loss  to  understand  why,  for  instance,  many 
forms  of  insanity  are  entirely  beyond  our  psycho- 
therapeutic  influences.  On  the  other  hand,  every 


1 66  PSYCHOTHERAPY 

physician  who  uses  psychotherapeutic  means  is  sur- 
prised to  see  the  effective  bodily  readjustment  where 
serious  disturbances  perhaps  of  the  circulatory  system 
or  the  digestive  system  existed.  What  the  methods 
can  do  and  what  they  cannot  do  must  simply  be  left 
to  experience,  but  of  course  to  an  experience  which  is 
eager  to  expand  itself  by  ever  new  experimental 
curative  efforts. 

From  this  point  of  view  we  can  see  clearly  the  gen- 
eral division  of  the  whole  field  of  possible  psycho- 
therapy. Psychotherapy  influences  psychophysical 
states  in  the  interest  of  health.  There  are  only  two 
possibilities  open:  either  the  disturbance  is  in  the 
psychophysical  system  itself  or  it  is  outside  of  it,  that 
is  in  the  other  parts  of  the  body  which  are  somehow 
under  the  influence  of  the  mind.  In  the  first  case 
when  the  disturbance  occurs  in  the  mind-brain  system 
itself,  we  ought  to  separate  two  large  groups,  first 
those  cases  in  which  the  system  itself  is  normal  and 
the  disturbance  comes  from  without,  and  second  those 
in  which  the  constitution  of  the  system  itself  was  ab- 
normal and  led  to  disturbances  under  conditions  in 
which  a  normal  system  would  not  have  suffered.  We 
have  to  consider  both  groups  somewhat  more  in  de- 
tail, as  each  again  allows  a  large  variety  of  cases. 

Thus  we  have  before  us,  first  the  normal  mind- 
brain  system  into  which  a  disturbance  breaks,  injuring 
more  or  less  severely  and  for  a  longer  or  shorter  time 
the  equilibrium  of  the  psychophysical  functions. 
Here  belong  any  bodily  processes  which  produce  pain 
or  any  bodily  defects  which  produce  blanks  in  the 


THE  FIELD  OF  PSYCHOTHERAPY  167 

content  of  consciousness;  the  pain  of  sciatica  or  of 
rheumatism,  or  the  defect  of  the  blind  or  of  the  deaf, 
certainly  interferes  in  a  disturbing  way  with  the  per- 
fect harmony  of  psychophysical  activities.  But  here 
also  belongs  the  suffering  which  results  from  con- 
ditions in  the  surroundings,  the  loss  of  a  friend,  a  dis- 
appointment in  life,  any  source  of  worry  and  grief. 
Social  and  bodily  conditions  alike  may  thus  work  to 
break  up  the  equilibrium.  The  pain  sensation  inter- 
feres with  the  normal  flow  of  mental  life  and  the 
grief  may  undermine  the  mental  interests.  The  psy- 
chotherapeutic  effort  may  be  directed  toward  remov- 
ing the  source  of  the  disturbance,  bringing  the  patient 
under  other  conditions,  curing  the  diseased  organ,  and 
where  that  is  not  possible,  may  work  directly  on  the 
psychophysical  state,  inhibiting  the  pain,  suppressing 
the  emotion,  substituting  pleasant  ideas,  distracting 
the  whole  mind,  filling  it  with  agreeable  feelings,  until 
the  normal  equilibrium  is  restored. 

The  psychophysical  system  itself  was  not  really 
harmed  by  such  influences.  In  the  following  groups, 
such  is  no  longer  the  case.  We  here  think  at  first 
of  those  severe  injuries  which  have  their  sources  in 
abnormal  processes  outside  of  the  brain.  The 
anaemia  of  the  patient  or  the  low  state  of  his  nu- 
trition or  the  fever  heat  of  his  blood  impairs  the  har- 
mony of  the  mental  functions.  Another  and  for  the 
psychotherapist  much  more  important  group  is  that 
in  which  the  impairment  results  from  toxic  influences. 
Alcohol,  morphine,  cocaine,  tobacco,  and  many  other 
drugs  may  have  been  misused  and  may  have  pro- 


1 68  PSYCHOTHERAPY 

duced  a  most  marked  alteration  in  the  mind-brain 
system.  Desires  may  have  developed  which  com- 
pletely destroy  the  balance  of  the  normal  functions 
and  yet  the  satisfaction  of  which  increases  the  poison- 
ing effect.  But  here  belongs  further  the  effect  of 
poisons  which  the  body  itself  produces:  the  toxic 
disturbance  of  uraemia  or  the  coma  in  diabetes,  or 
especially  the  grave  disturbances  resulting  from  the 
abnormal  action  of  the  thyroid  gland,  the  source  of 
cretinism.  Many  indications  suggest  that  a  near  fu- 
ture will  consider  this  group  much  larger  than  we  are 
really  justified  in  doing  today,  probably  soon  con- 
necting a  number  of  other  mental  diseases  like  de- 
mentia praecox  with  toxic  effects  of  bodily  origin. 
Experience  shows  that  in  this  group  not  a  few  chances 
exist  for  successful  psychotherapeutic  influence.  Yet 
the  means  may  be  various  in  character  and  their 
effect  may  be  a  direct  or  an  indirect  one.  A  psychical 
shock  may  remove  directly  the  mental  disturbance 
of  the  alcoholic  state,  but  it  is  more  important  that 
mental  suggestion  can  remove  the  alcoholic  disturb- 
ance indirectly  by  suppressing  the  desire  for  alcoholic 
excesses.  Even  where  cure  by  psychotherapeutic 
means  is  out  of  the  question,  as  is  the  case  with 
feverish  delirium  or  urasmic  excitements,  no  skilled 
physician  ignores  the  aid  which  a  well-adjusted  men- 
tal influence  can  offer  to  the  patient. 

We  come  to  a  third  group.  Some  outside  cause 
has  harmed  the  central  nervous  system  directly,  and 
has  left  it  in  a  disabled  state  after  the  cause  itself  has 
disappeared.  Such  causes  may  have  been  at  first 


THE  FIELD  OF  PSYCHOTHERAPY  169 

purely  functional :  for  instance,  a  neglect  of  training, 
or  a  wrong  training,  or  an  over-activity,  but  the  ill- 
adjusted  function  which  involved,  of  course,  every 
time  an  ill-adjusted  organic  activity  or  lack  of 
activity,  has  led  to  a  lasting  or  at  least  relatively  last- 
ing disturbance  in  the  system  of  paths.  The  neglect 
of  training,  for  instance,  in  periods  of  development 
may  have  resulted  in  the  retardation  which  yields  the 
symptoms  of  a  feeble-minded  brain,  or  the  wrong 
training  may  have  created  vicious  habits,  firmly 
established  in  the  mind-brain  system  and  gravely  dis- 
turbing the  equilibrium.  Above  all,  the  overstrain  of 
function,  especially  of  emotional  functions,  may  lead 
to  that  exhaustion  which  produces  the  state  of  neu- 
rasthenia. It  is  true  that  not  a  few  would  doubt 
whether  we  have  the  right  to  class  neurasthenia  here 
where  we  speak  of  the  harm  done  to  the  normal 
brain.  Many  neurologists  are  inclined  to  hold  that 
neurasthenia  demands  a  special  predisposition  and  is 
therefore  dependent  upon  a  neurotic  constitution  of 
the  brain  itself.  But  if  defenders  of  such  a  view,  as 
for  instance,  Dubois,  acknowledge  that  "  we  might 
say  that  everybody  is  more  or  less  neurasthenic,"  we 
can  no  longer  speak  of  any  special  predisposition. 
Certainly  there  exists  a  constitutional  neurasthenia 
sometimes  but  we  have  hardly  a  right  to  deny  that 
overstrain  in  the  brain  activity  may  produce  a  series 
of  neurasthenic  symptoms  in  any  brain,  and  the 
special  predisposition  is  responsible  rather  for  the 
particular  selection  among  the  innumerable  symptoms. 
Neurasthenia  certainly  is  the  classical  ground  for 


1 70  PSYCHOTHERAPY 

the  psychotherapist.  The  patient's  insomnia  and  his 
headache,  his  feeling  of  tiredness  and  his  disgust  with 
himself,  his  capricious  manias  and  his  absurd  phobias, 
his  obsessions  and  his  fixed  ideas  all  may  yield  to  the 
"  appeal  to  the  subconscious,"  and  as  a  neurasthenic 
easily  believes  in  the  existence  of  various  organic  dis- 
eases in  his  body,  Christian  Science  can  perform  here 
even  "  miracles."  In  the  case  of  retardation,  the 
psychical  influence  will  have  to  be  in  the  first  place 
one  of  training.  Yet  it  would  be  narrow  to  over- 
look that  in  neurasthenia,  too,  suggestion  has  to  be 
only  a  part  of  the  psychical  treatment.  Training 
and  rest,  distraction  and  sympathy  and  many  other 
factors  have  to  enter  into  the  plan.  Incomparably 
small,  on  the  other  hand,  is  the  aid  which  psycho- 
therapy can  offer  in  cases  of  real  destructions  in  the 
brain,  as  in  the  case  of  tumors,  hemorrhage,  paresis 
or  the  degeneration  by  senility.  More  effective  may 
be  its  work  in  concussion  of  the  brain  and  especially 
with  traumatic  neuroses,  as  in  the  case  when  a  rail- 
road accident  has  put  the  mind-brain  system  out  of 
gear. 

So  far  we  presupposed  that  the  central  system  itself 
was  normal.  No  sharp  separation  line,  however, 
lies  between  all  these  disturbances  and  the  equally 
large  group  of  psychophysical  disabilities  resulting 
from  a  defective  constitution  of  the  brain.  The 
normal  brain  shades  over  by  smallest  differences  into 
the  abnormal  one;  yes,  even  the  varieties  of  temper- 
ament and  character  and  intellectual  capacity  and  in- 
dustry and  energy  represent,  in  the  midst  of  our 


THE  FIELD  OF  PSYCHOTHERAPY  171 

social  surroundings,  large  deviations  from  the  stand- 
ard. That  which  might  still  pass  as  normal  under 
certain  conditions  of  life  would  be  unadjusted  and 
thus  abnormal  under  other  conditions.  In  the  same 
way,  we  certainly  cannot  point  out  where  the  natural 
constitution  of  a  brain  ceases  to  be  fit  for  its  organic 
purposes  and  where  the  structural  variations  are  ill- 
prepared  for  the  struggle  for  existence.  Just  as  we 
claimed  that  an  entirely  normal  brain  might  be 
brought  by  an  emotional  overstrain  to  a  state  of  ex- 
haustion and  disability,  we  may  claim  on  the  other 
side  that  a  brain  which  nature  has  poorly  provided 
may  yet  be  protected  against  damage  and  injury. 
The  inborn  factor  does  not  alone  decide  the  fate. 
Psychophysical  prophylaxis  may  secure  steadiness  of 
equilibrium  to  a  system  which  inherited  little  resist- 
ance. Yet  this  large  borderland  region,  where  an  ill- 
adjusted  brain  may  be  saved  or  lost  in  accordance 
with  favorable  or  unfavorable  circumstances,  shades 
off  again  to  the  darker  regions  where  the  inner  evolu- 
tion leads  by  necessity  to  disaster  even  under  favor- 
able conditions. 

We  might  begin  this  large  group  of  the  constitu- 
tional disturbances  with  that  neurasthenia  which  de- 
velops on  the  basis  of  inherited  disability.  Lack  of 
energy  resulting  from  a  feeling  of  tiredness,  a  quick 
exhaustion,  a  mood  of  depression,  an  easy  irritation, 
even  despair  and  self-accusation,  sullenness  and  fits  of 
anger,  cranky  inclinations  and  useless  brooding  over 
problems,  headache  and  insomnia  characterize  the 
picture  which  everyone  finds  more  or  less  developed 


1 72  PSYCHOTHERAPY 

in  some  of  his  acquaintances.  If  we  classify  symp- 
toms, we  may  separate  from  it  that  which  we  nowa- 
days are  inclined  to  call  psychasthenia.  An  abnormal 
suggestibility  for  autosuggestions  stands  in  the  fore- 
ground. Fixed  ideas  and  fixed  emotions,  especially 
fears,  trouble  the  patient.  He  may  pick  up  his 
obsession  by  any  chance  experience  and  no  goodwill 
liberates  him  from  the  intrusion  perhaps  for  years. 
The  patient  is  perfectly  well  aware  that  his  ideas  and 
his  emotions  are  unjustified,  he  himself  does  not  be- 
lieve in  them,  and  yet  they  come  with  the  strength  of 
an  outer  perception  and  with  the  vividness  of  a  real 
attitude,  and  his  whole  mental  equilibrium  may  be 
upset  by  the  continuous  fight  against  these  involuntary 
interferences.  In  the  light  cases,  sometimes  the  one 
and  sometimes  the  other  autosuggestion  may  hold 
the  stage;  in  the  severe  cases,  mental  life  turns  more 
and  more  around  certain  definite  fears  and  yet  it  may 
all  still  be  in  the  limits  where  the  daily  work  can  go 
on  and  the  world  may  not  know  of  the  hidden  tor- 
tures. Here  belongs  the  fear  of  open  places  or  the 
fear  of  touching  certain  objects,  the  fear  of  doing 
harm  to  others  or  the  fear  of  deciding  actions 
wrongly,  the  fear  of  destroying  valuable  things  or  the 
fear  of  being  the  center  of  public  attention,  the  fear 
of  crowds  or  of  closed  doors,  of  altitudes  or  of 
bridges.  And  in  all  cases  emotional  reaction  may  set 
in  with  anxieties,  and  bodily  symptoms  such  as  palpi- 
tation of  the  heart  may  result,  whenever  an  effort  is 
made  to  disregard  the  nervous  fear.  There  is  per- 
haps no  group  of  patients  which  so  much  deserves  the 


THE  FIELD  OF  PSYCHOTHERAPY  173 

most  careful  efforts  of  the  psychotherapist.  Still 
more  than  the  hysterics  they  suffer  from  the  fate  of 
seeing  their  ills  counted  as  not  real.  For  them  every- 
body has  the  good  advice  that  they  ought  to  over- 
come their  fancies;  and  yet  they  feel  their  life  ruined 
with  their  endless  fight  against  the  overpowering 
enemy.  And  if  anywhere,  it  is  here  that  the  psycho- 
therapist is  successful.  Psychasthenic  fear  can  be 
removed,  while  the  developed  melancholic  depression, 
for  instance,  is  entirely  beyond  the  reach  of  psychical 
influence. 

We  have  after  all  the  same  psychasthenic  state  be- 
fore us  when  the  obsession  has  impulsive  character, 
from  the  mere  abnormal  impulse  of  lying,  or  making 
noise  in  a  quiet  place  or  crying  in  the  dark,  or  touch- 
ing certain  places,  to  that  of  stealing,  indecent  speech, 
arson,  and  perhaps  even  murder.  The  symptoms 
might  easily  be  mistaken  for  those  of  graver  diseases. 
Yet  the  fact  that  the  patient  himself  really  does  not 
will  the  effect  at  which  he  is  aiming  separates,  mostly 
without  difficulty,  the  diagnosis  of  psychasthenia  from 
that  of  insanity.  Quite  nearly  related  to  it  are  the 
manifold  variations  of  abnormal  and  perverse  sexual 
tendencies.  The  psychiatrists  are  perhaps  too  much 
inclined  to  bring  all  these  pathological  impulses  and 
desires,  fears  and  anxieties,  into  the  nearest  neighbor- 
hood to  real  insanity.  The  indisputable  success  of 
psychotherapy  in  these  spheres  ought  to  add  a  warn- 
ing against  these  expansions  of  the  strictly  psychiatric 
domain.  The  psychologist  will  be  more  inclined  to 
emphasize  their  relation  to  simple  neurasthenia  which 


i74  PSYCHOTHERAPY 

itself   imperceptibly  shades   over   into   our   normal 
life. 

All  neurasthenic  and  psychasthenic  disabilities 
show  a  certain  emotional  continuity  and  uniformity. 
It  is  the  emotional  instability  and  the  quick  alternation 
of  symptoms  which  characterize  hysteria  or  rather 
the  hysterias.  It  seems  as  if  science  were  near  to 
the  point  of  explaining  the  hysterical  disease  by  one 
common  principle,  but  certainly  the  symptoms  are  an 
inexhaustible  manifold.  The  rapid  changes  of  the 
intense  moods  of  the  patient  usually  stand  in  the  cen- 
ter.Torturing  obsessions,  abnormal  impulses,  over- 
suggestibility,  hypochondriac  depressions,  paralysis 
of  arms  or  legs,  anaesthesia  and  parzesthesia,  a  mental 
stupor  and  confusion,  illusions  and  perceptions  of 
physiological  symptoms  may  work  together  in  spite 
of  his,  or  rather  her  clear  intelligence.  It  is  prob- 
ably on  a  hysteric  basis  also  that  somnambulic  states 
arise  during  the  night,  and  from  them  a  straight  way 
leads  to  those  mental  attacks  after  which  the  memory 
is  entirely  lost,  or  for  which  fundamental  associative 
connections  are  cut  off.  And  from  here  we  come  to 
the  exceptional  cases  of  alternating  personality.  The 
more  we  recognize  the  myriad  symptoms  in  the  hys- 
teric patient  as  products  of  the  emotional  instability, 
of  autosuggestibility  and  of  inhibition,  the  more  we 
understand  the  almost  miraculous  result  of  psy- 
chotherapeutic  treatment.  Autosuggestions  can  be 
fought  by  countersuggestions,  anaesthesia  and  par- 
aesthesia  can  be  removed  often  in  an  instant,  dis- 
sociated personalities  may  be  built  up  again  through 


THE  FIELD  OF  PSYCHOTHERAPY  175 

hypnotism,  the  most  severe  bodily  symptoms  may  dis- 
appear by  influences  in  a  waking  state.  Hysteria 
alone  would  justify  the  demand  that  every  physician 
in  his  student  days  pass  with  open  eyes  through  the 
field  of  psychology.  Quite  near  stand  chorea  and 
the  epidemic  impulses  to  imitative  movements.  And 
we  might  bring  into  this  neighborhood  also  the  dis- 
turbance in  the  equilibrium  of  the  speech  movements 
through  all  degrees  of  stammering  and  severe  im- 
pairment. Up  to  a  certain  degree,  though  not  often 
completely,  they  too  yield  easily  to  psychotherapeutic 
influence. 

We  enter  now  that  region  of  constitutional  dis- 
turbances in  which  psychotherapy  is  of  small  help. 
It  leads  from  epilepsy  to  the  periodic  diseases,  espe- 
cially the  maniacal  depressive  insanity,  the  paranoia 
which  develops  late,  and  finally  to  states  of  idiocy 
which  cover  the  whole  life.  We  are  far  from  claim- 
ing that  psychical  influences  are  entirely  powerless, 
the  more  as  we  insisted  that  psychotherapy  goes 
much  beyond  mere  suggestions  and  appeals.  No 
psychiatrist  will  work  without  psychological  tools 
when  he  deals  with  the  exultations  of  the  maniac 
and  the  depressions  of  the  melancholic,  with  the  hal- 
lucinations of  persecution  or  the  erotic  insanities  of 
the  paranoiac.  Still  more  the  whole  register  of 
psychology  has  to  be  used,  when  we  are  to  educate 
the  idiot  and  the  imbecile.  But  the  disappearance  of 
the  disease  or  of  the  chief  symptoms  through  the 
mental  agencies  is  in  all  these  cases  out  of  the  question. 
Only  in  incipient  cases,  especially  of  melancholia  and 


1 76  PSYCHOTHERAPY 

mania,  the  psychotherapeutic  work  seems  not  entirely 
hopeless ;  and  for  epilepsy  some  distinct  successes  can- 
not be  denied. 

We  have  reviewed  the  whole  field  of  psychophys- 
ical  disturbances,  those  produced  through  external  con- 
ditions in  the  normal  brain  and  those  resulting  from 
abnormal  brain  constitution.  We  have  seen  that  the 
work  of  the  psychotherapist  is  of  very  unequal  value 
in  different  parts  of  the  field;  in  some,  as  in  neuras- 
thenia, in  psychasthenia,  in  hysteria  and  similar 
regions  most  effective,  in  others  like  paresis  or  para- 
noia reduced  to  an  almost  insignificant  factor.  Where 
it  can  help  and  where  not  we  recognize  as  a  mere 
question  of  experience.  Certainly  the  severity  of  the 
symptoms  alone  does  not  decide  it.  As  the  treatment 
is  entirely  empirical,  no  one  can  foresee  whether  or 
not  the  situation  may  change  tomorrow.  We  may 
find  psychotherapeutic  schemes  by  which  epilepsy  or 
maniacal  depressive  insanity  or  traumatic  neuroses 
may  become  accessible.  We  simply  do  not  know  why 
we  may  remove  stammering  or  synthesize  a  dissoci- 
ated personality  or  overcome  an  inborn  sexual  per- 
versity, while  we  are  unable  to  remove  the  depression 
of  the  melancholic.  Certainly  the  symptoms  of  the 
circulatory  insanity  disappear  completely  in  the  free 
intervals;  there  is  no  reason  to  give  up  hope  that 
psychotherapy  might  find  the  way  to  hasten  the  ap- 
pearance of  such  a  normal  period. 

But  we  have  emphasized  from  the  start  that  the 
psychotherapeutic  work  has  not  only  to  set  in  when 
the  disturbance  itself  lies  in  the  psychophysical  sys- 


THE  FIELD  OF  PSYCHOTHERAPY  177 

tern.  We  may  utilize  the  influence  which  the  mind- 
brain  system  has  for  the  whole  body  and  thus  may 
apply  the  psychical  tool  to  work  on  the  disturbances 
in  the  bodily  apparatus.  We  may  discriminate  a 
direct  and  an  indirect  influence  in  the  psychical 
treatment  of  bodily  diseases.  Transition  from 
the  foregoing  group  of  psychical  disturbances 
offers  itself  perhaps  most  easily  through  the  state  of 
insomnia. 

The  causes  of  sleeplessness  may  still  lie  in  the 
psychophysical  sphere;  restless  thoughts  may  inhibit 
the  idea  of  sleep.  The  effect  of  sleep  is  again  in  the 
sphere  of  the  mind,  the  annihilation  of  conscious 
contents.  But  the  center  which  regulates  and  creates 
the  sleep,  probably  by  contracting  the  blood-vessels, 
lies  outside  of  the  psychophysical  system  in  the  lower 
centers  of  the  brain.  The  real  disturbance  thus  lies 
in  the  inactivity  of  this  purely  bodily  apparatus  and 
mental  influence  which  is  to  create  sleep  has  there- 
fore to  work  downwards  from  the  mind  to  a  bodily 
organ.  In  the  same  way  many  other  non-psychical 
centers  of  the  brain  may  be  brought  to  efficiency 
through  psychophysical  regulation. 

But  the  therapeutic  effect  is  certainly  not  confined 
to  the  central  nervous  system.  Whithersoever  the 
centrifugal  nerves  lead  there  the  mind-brain  system 
may  have  its  curative  influence.  In  the  most  startling 
way  that  is  true  for  the  digestive  apparatus.  The 
secretions  of  the  stomach,  the  activity  of  the  intes- 
tines can  be  influenced  to  a  decree  which  it  is  diffi- 
cult to  explain.  Important  also  is  the  relation  to  the 


178  PSYCHOTHERAPY 

circulatory  system,  especially  the  disturbances  of  the 
heart:  innervation  may  be  corrected,  abnormal  dila- 
tions and  contractions  of  blood-vessels  may  be  regu- 
lated. The  bladder,  uterus,  even  the  pancreas  and 
the  liver  seem  to  be  influenced  by  the  peripheral 
effects  of  the  central  excitement.  And  while  no  warn- 
ing can  be  serious  enough  against  the  absurd  belief 
that  diseases  like  cancer  or  tuberculosis  can  be  cured 
by  faith,  it  must  be  admitted  that  psychical  influences 
under  special  conditions  may  have  a  retarding  influ- 
ence on  any  pathological  process  in  the  organism. 
Much  of  that  certainly  is  indirect  influence  but  the 
physician  would  be  reckless  if  he  should  ignore  the 
aid  which  may  result  from  such  indirect  assistance. 
Even  if  psychotherapy  could  not  do  more  in  the  treat- 
ment of  bodily  diseases  than  to  secure  a  joyful 
obedience  to  the  strict  demands  of  the  physician, 
it  would  yet  have  to  be  accredited  with  an  extremely 
important  service. 

In  a  parallel  line  comes  the  effective  aid  by  the 
stimulation  of  hope  and  the  suppression  of  fear,  by 
suggestion  of  a  feeling  of  encouragement  and  the 
inhibition  of  the  emotions  of  worry.  This  is  a  field 
where  even  the  average  physician  is  most  easily  in- 
tlined  to  play  the  amateur  psychotherapist.  He 
Knows  how  convalescence  is  disturbed  by  psychical 
depression  and  how  much  more  quickly  health  re- 
turns, if  it  is  confidently  expected;  he  knows  how 
many  dangerous  operations  are  disturbed  by  de- 
spondency and  helped  by  bravery;  he  knows  what  a 
blessed  change  has  come  into  the  treatment  of  tuber- 


THE  FIELD  OF  PSYCHOTHERAPY  179 

culosis  since  a  psychical  factor  of  social  interest  has 
set  in ;  he  knows  how  many  ills  disappear  when  regu- 
lar occupation  and  interesting  work  are  established  or 
the  strain  of  distasteful  work  removed.  Even  the 
mere  suppression  of  the  pain  works  backwards  on  the 
bodily  disease  which  produces  it.  The  pain  was  a 
starting  point  for  disturbing  reactions;  with  its  dis- 
appearance through  psychotherapeutic  influence,  the 
reactions  of  the  irritated  brain  come  to  rest,  the  dis- 
eased body  can  carry  on  its  struggle  without  inter- 
ference and  may  win  the  day.  Often  the  psychical 
influence  may  not  even  change  the  symptoms  at  all 
but  may  remove  other  troublesome  effects.  The  suf- 
ferer from  locomotor  ataxia  may  learn  to  walk  again 
through  mental  education  without  any  restitution  of 
his  spinal  cord.  In  short,  there  are  endless  ways  in 
which  psychical  influence  may  work  towards  the  gen- 
eral health  and  towards  the  victory  over  bodily  dis- 
ease; and  all  that  may  be  acknowledged  without  the 
slightest  concession  to  the  metaphysical  creeds  of 
mental  healers  and  Christian  Scientists.  But  to  make 
use  of  those  means  and  to  harness  such  influences,  it 
cannot  be  enough  to  rely  on  the  common-sense  of  the 
physician  any  more  than  we  should  trust  the  common- 
sense  of  the  surgeon  to  use  his  knife  without  con- 
descending to  the  study  of  anatomy.  The  psycholog- 
ical study  of  the  anatomy  of  the  soul  shows  a  not 
less  complicated  system  of  mental  tissues  and  mental 
elements. 

To  enter  into  the  full  richness  of  this  whole,  large 
field  of  course  lies  entirely  beyond  the  scope  of  our 


i8o  PSYCHOTHERAPY 

short  discussion,  which  seeks  as  its  only  aim  a  clear 
recognition  of  the  principles.  Yet  it  seems  essential 
to  illustrate  at  least  this  sketch  of  the  field  by  a  more 
detailed  account  of  actual  developments.  Various 
ways  of  procedure  might  appear  in  order  and  the 
most  natural  one  would  be,  of  course,  to  pass  down 
from  disease  to  disease  and  sketch  special  cases  from 
diagnosis  to  cure.  We  might  go  through  the  various 
stages  of  neurasthenia  and  then  through  psychas- 
thenia  and  then  through  hysteria  and  so  on.  And  if 
we  had  to  write  a  handbook  for  physicians,  it  would 
certainly  be  the  desirable  way,  in  spite  of  the  too  fre- 
quent repetitions  which  would  become  necessary.  But 
as  our  aim  is  only  a  discussion  of  principles  of  psycho- 
therapy, we  have  no  right  to  use  this  method. 
Moreover,  such  a  method  would  suggest  the  mis- 
leading view  that  the  psychotherapist  is  called  and  is 
able  to  treat  diseases.  All  that  he  treats  are  symp- 
toms and  he  ought  not  to  pretend  that  he  can  do 
more,  as  long  as  he  abstracts  from  all  other  thera- 
peutic agencies.  Psychotherapeutic  influence  may  re- 
move the  phobia  of  a  psychasthenic  or  the  obsession 
of  a  neurasthenic  or  the  emotion  of  a  hysteric,  and 
thus  may  bring  not  only  momentary  relief  but  a 
change  which  may  be  favorable  for  general  improve- 
ment, but  certainly  the  neurasthenia  and  psychasthenia 
and  hysteria  are  not  really  removed  by  it.  Of  course, 
even  the  treatment  of  symptoms  demands  a  constant 
reference  to  the  whole  background  of  the  disease. 
The  depression  of  the  neurasthenic  must  not  be 
treated  like  the  depression  of  the  melancholic,  the 


THE  FIELD  OF  PSYCHOTHERAPY  181 

obsession  of  the  psychasthenic  must  not  be  mixed 
with  the  fixed  ideas  of  a  paranoiac,  the  hysteric  in- 
ability to  walk  must  not  be  confused  with  an  injury  of 
the  motor  nerves;  in  short,  each  symptom  has  to  be 
treated  as  part  of  a  complete  situation.  The  efforts 
of  the  psychotherapist  will  move  over  as  large  a  part 
of  the  disease  as  possible  and  cover,  perhaps,  the 
causes  of  the  disturbance  as  far  as  they  are  of  psy- 
chical origin.  Yet  it  would  remain  dilettanteism  if  we 
were  to  accept  the  popular  view  that  the  mere  psycho- 
therapeutic  aid  is  a  sufficient  treatment  of  the  whole 
disease.  The  physician  has  to  be  much  more  than  a 
psychotherapist.  Our  discussion  only  seeks  to  point 
out  that  whatever  else  he  may  be,  he  must  be  also  a 
psychotherapist. 

The  more  conservative  method  which  befits  us  may 
be,  therefore,  the  method  of  dealing  with  symptoms 
only  and  abstracting  from  the  more  ambitious  plan  of 
discussing  the  diseases  entire.  We  simply  separate 
the  mental  symptoms  and  the  bodily  symptoms  which 
the  psychotherapist  is  to  remove.  And  just  in  order 
to  classify  somehow  the  manifold  mental  symptoms, 
we  might  separate  those  in  the  sphere  of  ideas,  those 
in  the  sphere  of  emotions,  and  those  in  the  sphere  of 
volitions.  Of  course,  nothing  is  further  from  such 
a  plan  than  the  old-fashioned  belief  that  intellect, 
feeling,  and  will  represent  three  independent  faculties 
of  the  soul.  Modern  psychology  has  not  only  sub- 
stituted the  millionfold  phenomena  for  the  schematic 
faculties,  but  emphasizes  above  all  the  interconnected- 
ness  of  the  mental  facts.  There  is  no  experience  into 


1 82  PSYCHOTHERAPY 

which  ideas,  and  feelings,  and  impulses  do  not  enter 
together.  And  correspondingly  we  emphasized  that 
on  the  physiological  side  too,  every  sensory  excite- 
ment is  at  the  same  time  the  middle  point  of  central 
irradiation  and  the  starting  point  of  motor  activity. 
Thus  there  can  be  no  disturbance  of  ideas  which  does 
not  influence  feeling  and  will,  and  vice  versa.  Yet 
it  would  be  artificial  to  deny  that  any  one  of  those 
various  sides  of  the  psychical  process  may  come  to 
prominence,  sometimes  the  impulse,  sometimes  the 
emotion,  and  sometimes  the  interplay  of  ideas.  The 
separation  means  only  an  abstraction,  but  it  is  an 
abstraction  which  is  justified  and  suggested  by  the 
actual  experiences.  Thus  we  shall  deal  with  the 
psychical  treatment  of  ideational,  emotional,  voli- 
tional, and  bodily  symptoms. 

Common  to  our  discussions  will  be  only  the  effort 
to  avoid  everything  which  is  exceptional  and  by  its 
unusual  complications  apparently  unexplainable  and 
mysterious.  The  greater  complexity  of  the  case  cer- 
tainly adds  much  fascination.  Yet  since  we  do  not 
want  to  stimulate  mere  curiosity  but  clear  under- 
standing of  the  elements,  we  avoid  every  startling 
record.  We  confine  ourselves  carefully  to  those  per- 
haps trivial  experiences  which  daily  enter  into  the 
view  of  those  who  come  in  contact  with  suffering 
mankind.  There  will  be  no  startling  stories  of  dis- 
sociated personalities,  such  as  appear  perhaps  every 
few  years  on  the  horizon  of  the  medical  world,  but 
we  shall  speak  of  those  who  every  day  in  every  town 
carry  their  trouble  to  the  waiting  room  of  the  doctor 


THE  FIELD  OF  PSYCHOTHERAPY  183 

and  who  might  return  more  happily  if  he  had  more 
well-trained  interest  in  the  psychotherapeutic  factors. 
Yet  before  we  analyze  some  typical  symptoms,  it 
might  be  wise  to  review  the  whole  series  of  means  and 
tools  which  the  psychotherapist  finds  at  his  disposal. 


ym 

THE  GENERAL  METHODS  OF 
PSYCHOTHERAPY 

THE  psychological  work  of  the  physician  does 
not  begin  with  his  curative  efforts.  Therapy 
is  always  only  the  last  step.  Diagnosis  and 
observation  have  to  precede,  and  an  inquiry  into  the 
causes  of  the  disease  is  essential,  and  in  every  one  of 
these  steps  psychology  may  play  its  role.  The  means 
of  psychodiagnostic  are  not  less  manifold  than  those 
of  psychotherapy.  Moreover  there  the  technique 
may  be  more  complex  arid  subtle.  The  whole  equip- 
ment of  the  modern  laboratory  ought  to  be  put  at  its 
disposal.  Perceptions  and  associations,  reactions  and 
expressions  ought  to  be  examined  with  the  same 
carefulness  with  which  the  conscientious  physician 
examines  the  blood  and  the  urine. 

A  particular  difficulty  of  the  task  more  or  less 
foreign  to  every  other  medical  inquiry  is  the 
intentional  or  unintentional  effort  of  the  patient 
to  hide  the  sources  of  the  trouble  and  to  mislead 
as  to  their  true  character.  Too  often  he  is  en- 
tirely unconscious  of  the  sources  of  trouble  or 
else  he  has  social  reasons  to  deceive  the  world  and 
himself,  and  ultimately  the  physician.  And  yet  no 

psychical  treatment  can  start  successfully  so  long  as 

184 


GENERAL  METHODS  185 

the  patient  is  brooding  on  secret  thoughts  at  the  bot- 
tom of  his  mind.  The  desire  to  hide  them  may  often 
be  itself  a  part  of  the  disease.  It  is  surprising  how 
often  unsuspected  vistas  of  thoughts  and  impulses  .and 
emotions  are  opened  by  an  inquiring  analysis  where 
the  direct  report  of  the  patient  does  not  awaken  the 
least  suspicion.  In  the  field  of  insanity,  naturally  the 
physician  at  once  goes  to  an  examination  on  his  own 
account,  but  in  the  borderland  regions  of  the  psychas- 
thenics  and  hysterics  and  neurasthenics,  the  intellec- 
tual clearness  of  the  patient  too  easily  tempts  one 
into  trusting  the  sincerity  of  his  story;  and  yet  the 
most  important  ideas  clustering  perhaps  about  love 
or  ambition,  about  vice  or  crime,  about  business  fail- 
ure or  family  secrets,  about  inherited  or  acquired  dis- 
eases may  be  cunningly  withheld  and  may  frustrate 
every  psychotherapeutic  influence.  Where  suspicion 
is  awake  and  mere  confidential  talk  and  persuasion 
seem  insufficient,  the  physician  may  feel  justified  in 
the  interest  of  his  patient  in  drawing  the  thoughts  out 
of  their  hiding-place  by  artificial  means.  Skill,  tact, 
and  experience  are  needed  there.  , 

As  a  matter  of  course,  in  the  overwhelming  mass  of 
cases  the  frankness  and  the  good  will  of  the  patient 
himself  will  support  the  physician  and  accordingly 
his  examination  is  not  obliged  to  trap  the  patient  but 
simply  to  guide  him  to  important  points.  But  then 
begins  the  most  essential  study  of  diagnostical  dif- 
ferentiation. With  all  the  means  not  only  of  psychol- 
ogy but  of  neurology  and  internal  medicine,  he  has  to 
separate  the  particular  case  from  similar  ones  and  to 


186  PSYCHOTHERAPY 

examine  whether  he  deals  with,  for  instance,  a  hys- 
teric or  with  a  paranoiac,  with  a  neurasthenic  or  with 
a  case  of  dementia  praecox;  and  he  will  not  forget  that 
there  exist  almost  no  symptoms  of  serious  diseases 
which  the  nervous  system  of  the  hysteric  may  not  imi- 
tate for  a  time.  Not  ours  is  the  task  of  analyzing 
special  methods  of  neurological  and  mental  differ- 
ential diagnosis  such  as  are  used  in  the  psychiatric 
clinic  and  in  the  office  of  the  nerve  specialist.  There 
the  family  history  with  reference  to  nervous  and  other 
diseases,  the  history  of  the  patient  himself,  the  infec- 
tious diseases  which  he  has  passed  through,  his  habits 
and  anomalies,  his  use  of  alcohol  and  of  drugs,  his  ex- 
periences in  social  life,  the  demands  of  his  profession, 
his  recent  troubles  and  their  first  origin  are  to  be 
recorded  carefully.  Then  begins  the  physical  ex- 
amination, the  study  of  his  sense  organs  and  his 
nerves,  of  the  motor  inabilities,  the  pains,  the  local 
anaesthesias  and  parsesthesias,  the  disturbances  of  the 
reflexes,  of  the  spasms,  tremors,  convulsions,  and  inco- 
'  ordinations,  of  the  vasomotor  and  trophic  disorders, 
and  so  on.  In  a  similar  way  the  psychical  examina- 
tion tests  the  hallucinations  and  illusions,  the  varia- 
tions and  defects  of  memory  and  attention,  of  judg- 
ment and  reasoning,  of  orientation  and  self-conscious- 
ness, of  emotions  and  volitions,  of  intellectual  capaci- 
ties and  organized  actions.  But  we  do  not  have  to 
enter  here  into  a  discussion  of  such  diagnostic  means ; 
our  chief  interest  belongs  to  the  therapy. 

The  variety  of  the  psychotherapeutic  methods  is 
great  and  only  some  types  are  to  be  characterized 


GENERAL  METHODS  187 

here.  But  one  rule  is  common  to  all  of  them :  never 
use  psychotherapeutic  methods  in  a  schematic  way  like 
a  rigid  pattern.  Schematic  treatment  is  a  poor  treat- 
ment in  every  department  of  medicine,  but  in  psycho- 
therapeutics  it  is  disastrous.  There  are  no  two  cases 
alike  and  not  only  the  easily  recognizable  differences 
of  sex  and  age,  and  occupation  and  education,  and  fi- 
nancial means,  and  temperament  and  capacity  are  de- 
cisive, but  all  the  subtle  variations  of  prejudices  and 
beliefs,  preferences  and  dislikes,  family  life  and  social 
surroundings,  ambitions  and  prospects,  memories  and 
fancies,  diet  and  habits  must  carefully  be  considered. 
Every  element  of  a  man's  life  history,  impressions  of 
early  childhood,  his  love  and  his  successes,  his  dis- 
eases and  his  distresses,  his  acquaintances  and  his  read- 
ing, his  talent,  his  character,  his  sincerity,  his  energy, 
his  intelligence — everything — ought  to  determine  the 
choice  of  the  psychotherapeutic  steps.  As  it  is  en- 
tirely impossible  to  determine  all  those  factors  by  any 
sufficient  inquiry,  most  of  the  adjustment  of  method 
must  be  left  to  the  instinct  of  the  physician,  in  which 
wide  experience,  solid  knowledge,  tact,  and  sympathy 
ought  to  be  blended.  Even  the  way  in  which  the  pa- 
tient reacts  on  the  method  will  often  guide  the  instinct 
of  the  well-trained  psychotherapist. 

It  is  therefore  certainly  not  enough  that  the  knowl- 
edge of  the  physician  simply  decide  beforehand  on  a 
definite  course  of  psychical  treatment  and  leave  the 
carrying  out  to  a  well-meaning  minister  or  any  other 
medical  amateur  who  schematically  follows  the  indi- 
cated path.  The  finest  adjustment  has  to  come  in 


1 88  PSYCHOTHERAPY 

during  the  treatment  itself  and  the  response  of  the 
patient  often  has  to  suggest  entirely  new  lines  of  pro- 
cedure. More  than  in  any  other  field  of  medicine, 
the  physician  himself  has  to  extend  his  influence  far 
beyond  the  office  hours  and  the  strictly  medical  rela- 
tions. And  yet,  on  the  other  hand,  there  is  no  depart- 
ment of  medicine  in  which  the  treatment  might  not 
profit  by  the  psychotherapeutic  influence.  With  a 
few  vague  words  of  encouragement  mechanically  ut- 
tered, or  with  a  routine  of  tricks  of  suggestion  by 
bread  pills  and  colored  water  and  tuning  forks,  not 
much  will  be  gained  even  in  the  ordinary  physician's 
practice.  Subtle  adjustment  to  the  personal  needs  and 
to  the  individual  conditions  is  necessary  in  every  case 
where  the  psychical  factor  is  to  play  an  important 
role.  It  cannot  be  denied  that  the  one  great  obstacle 
in  the  work  of  the  routine  physician  is  the  lack  of  time 
and  patience  which  is  needed  for  successful  treatment. 
To  prescribe  drugs  is  always  quicker  than  to  influence 
the  mind;  to  cure  a  morphinist  by  hyoscine  needs  less 
effort  than  to  cure  him  by  suggestion. 

The  first  method  to  bring  back  the  psychophysical 
equilibrium  is  of  course  the  one  which  is  also  de- 
manded by  common-sense,  namely,  to  remove  the  ex- 
ternal sources  of  the  disturbance.  External  indicates 
there  not  only  the  outer  world  but  also  the  own  body 
outside  the  conscious  parts  of  the  brain.  If  we  take 
it  in  the  widest  meaning,  this  would  evidently  include 
every  possible  medical  task  from  filling  a  painful 
tooth  to  operating  on  a  painful  appendix,  as  in  every 
case  where  pain  results,  the  mental  equilibrium  is  dis- 


GENERAL  METHODS  189 

turbed  by  it  and  the  normal  mental  life  of  the  patient 
reduced  in  its  efficiency.  But  in  the  narrower  sense 
of  the  word,  we  shall  rather  think  of  those  sources 
of  trouble  in  the  organism  itself  which  interfere  di- 
rectly with  the  mental  functions.  The  examination 
of  any  public  school  quickly  leads  to  the  discovery 
that  much  which  is  taken  for  impaired  mental  activity, 
for  lack  of  attention,  for  stupidity,  or  laziness  may 
be  the  result  of  defective  hearing  or  sight  or  ab- 
normal growth  of  the  adenoids.  Growths  in  the  nose 
may  be  operated  upon,  the  astigmatic  or  the  short- 
sighted eye  may  be  corrected  by  glasses,  the  child  who 
is  hard  of  hearing  may  at  least  be  seated  near  the 
teacher;  and  the  backward  children  quickly  reach  the 
average  level.  No  doubt  in  the  life  of  the  adult  as 
well,  often  almost  insignificant  and  from  a  strictly 
physical  point  of  view  unimportant  abnormities  in  the 
bodily  system,  especially  in  the  digestive  and  sexual 
spheres,  are  sources  of  irritation  which  slowly  influ- 
ence the  whole  personality.  To  be  sure,  the  brain 
disturbance  may  have  reached  a  point  where  the  mere 
removal  of  the  original  affliction  is  not  sufficient  to  re- 
instate the  normal  balance  of  mental  energies,  but 
wherever  such  a  bodily  irritation  goes  on,  it  is  never 
too  late  to  abolish  it  in  the  interests  of  psychotherapy. 
The  less  evident  and  yet  even  more  important 
source  of  the  painful  intrusions  may  lie  outside  of  the 
organism  in  the  social  surroundings  and  conditions  of 
life.  Most  of  that  has  to  be  accepted.  The  physician 
cannot  bring  back  the  friend  who  died  or  the  fortune 
which  was  lost  in  speculation  or  the  man  who  married 


1 90  PSYCHOTHERAPY 

another  girl.  He  will  even  avoid  suggesting  far- 
reaching  social  changes  in  the  private  life  of  the  pa- 
tient, changes  like  divorce  in  an  unhappy  marriage 
or  the  breaking  of  the  home  ties,  however  often  he 
may  get  the  impression  that  such  a  liberation  would 
stop  the  source  of  the  mental  trouble.  He  will  be 
the  more  careful  not  to  overstep  his  medical  rights 
as  he  seldom  has  the  possibility  to  judge  fairly  on  the 
basis  of  the  one-sided  complaint,  and  the  probability 
is  great  that  the  character  and  temperament  of  the 
complainant  may  be  a  more  essential  factor  of  the 
ailment  than  the  personalities  which  surround  him. 
Yet  even  the  conservative  physician  will  find  abun- 
dant opportunities  for  advice  which  will  remove  dis- 
turbing energies  from  the  social  surroundings  of  the 
sufferer.  Even  a  short  release  from  the  burdening 
duties,  a  short  vacation  from  the  incessant  needs  of 
the  nursery,  a  break  in  the  monotony  of  the  office, 
may  often  do  wonders  with  a  neurasthenic.  Often 
within  a  surprisingly  short  time  the  brain  gathers  the 
energies  to  overcome  the  frictions  with  unavoidable 
surroundings. 

Yet  here  the  physician  has  to  adjust  the  prescribed 
dose  of  outing  very  carefully  to  the  special  case.  We 
may  be  guided  by  the  psychological  experiments  whish 
have  been  made  in  the  interest  of  testing  the  fatigue 
induced  by  mental  work.  If  perhaps  four  hours  of 
concentrated  work  are  done  without  pauses,  experi- 
ment shows  that  the  quality  of  the  work  deteriorates, 
measured  for  instance  by  the  number  of  mistakes  in 
quick  calculation.  If  certain  relatively  long  pauses 


GENERAL  METHODS  191 

are  introduced,  the  standard  of  work  can  be  kept 
high  all  through.  But  if  frequent  pauses  are  made, 
and  each  short,  the  result  is  with  many  individuals  the 
opposite.  The  experiment  indicates  that  these  fre- 
quent pauses  are  working  as  interruptions  which 
hinder  the  perfect  adjustment  to  the  work  in  hand. 
That  is  suggestive.  Our  neurasthenic  may  complain 
about  the  life  which  he  has  to  live  and  yet  after  all 
he  is  frequently  so  completely  adjusted  to  it  that  it 
may  not  be  in  his  interest  to  remove  "him  far  away 
from  the  conditions  which  cannot  ultimately  be 
changed  but  to  which  he  has  to  return.  The  instinct 
of  the  physician  has  to  find  the  middle  way  between  a 
temporary  removal  of  irritation  which  really  allows 
a  development  of  new  energies  and  a  mere  interrup- 
tion which  simply  damages  the  acquired  relative  ad- 
justment. Every  cause  of  friction  which  can  be  per- 
manently annihilated  for  the  patient  certainly  should 
be  removed. 

This  negative  remedy  demands  its  positive  supple- 
ment. The  patient  must  be  brought  under  conditions 
and  influences  which  give  fair  chances  for  the  recu- 
peration of  his  energies.  Too  often  from  the  stand- 
point of  the  psychologist,  the  prescription  is  simply 
rest.  As  far  as  rest  involves  sleep,  it  is  certainly  the 
ideal  prescription.  There  is  no  other  influence  which 
builds  up  the  injured  central  nervous  system  as  safely 
as  sound  natural  sleep,  and  loss  of  sleep  is  certainly 
one  of  the  most  pernicious  conditions  for  the  brain. 
Again  rest  is  a  great  factor  in  those  systematic  rest 
cures  which  for  a  long  while  were  almost  the  fashion 


1 92  PSYCHOTHERAPY 

with  the  neurologist  Experience  has  shown  that 
their  stereotyped  use  is  often  unsuccessful,  and  more- 
over that  the  advantage  gained  by  those  months  spent 
in  bed  completely  isolated  and  overfed  is  perhaps  due 
to  the  separation  and  changed  nutrition  more  than  to 
the  overlong  absolute  rest.  Yet  used  with  discrimina- 
tion, the  physiological  and  the  psychical  effect  of  ly- 
ing in  bed  for  a  few  weeks  has  certainly  often  been 
a  marked  improvement,  especially  with  young  women. 
But  more  often  the  idea  of  rest  in  bed  during  day- 
time is  not  meant  at  all  when  the  nerve  specialist 
recommends  rest  to  his  over-strained  patient.  It  is 
simply  meant  that  he  give  up  his  fatiguing  daily  work, 
even  if  that  work  is  made  up  of  a  round  of  entertain- 
ments and  calls  and  social  engagements.  The  neuras- 
thenic and  all  similar  varieties  are  sent  away  from  the 
noise  of  the  city,  away  from  the  rush  of  their  busy 
life,  away  from  telephones  and  street  cars,  away  from 
the  hustling  business  and  politics. 

Indeed  it  is  the  dogma  of  most  official  and  unoffi- 
cial doctors  that  the  restlessness  and  hurry  and  noise 
which  all  are  characteristic  of  the  technical  condi- 
tions of  our  time  are  the  chief  sources  of  the  prevail- 
ing nervousness.  There  was  no  time  in  the  history 
of  civilization  in  which  the  average  man  was  over- 
whelmed by  so  many  demands  on  his  nerve  energy,  no 
time  which  asked  such  an  abundance  of  interests  even 
from  the  school  child.  The  wild  chase  for  luxury  in 
the  higher  classes,  reenforced  by  the  commercialism 
of  our  time,  the  hard  and  monotonous  labor  in  our 
modern  mills  and  mines  for  the  lower  classes,  the 


GENERAL  METHODS  193 

over-excitement  brought  to  everybody  by  the  sensa- 
tionalism of  our  newspapers  and  of  our  public  life  all 
injure  the  brain  cells  and  damage  the  equilibrium. 
That  is  a  story  which  we  hear  a  thousand  times  now- 
adays. Yet  1t  is  doubtful  whether  there  is  really 
much  truth  in  such  a  claim  and  whether  much  wise 
psychotherapy  can  be  deduced  from  it. 

We  may  begin  even  with  the  very  justifiable  doubt 
whether  nervousness  really  has  increased  in  our  time. 
Earlier  periods  had  not  so  many  names  for  those 
symptoms  and  were  not  able  to  discriminate  them 
with  the  same  clearness.  Above  all,  the  milder  forms 
of  abnormities  were  not  looked  on  as  pathological 
disturbances.  If  a  man  has  a  pessimistic  tempera- 
ment, or  has  fits  of  temper,  or  cannot  get  rid  of  a  sad 
memory  idea,  or  imagines  that  he  feels  an  illness 
which  he  does  not  have,  or  has  no  energy  to  work, 
even  today  most  people  are  still  without  suspicion 
that  a  neurasthenic  or  a  psychasthenic  or  a  hysteric 
disturbance  of  the  nervous  system  may  be  in  its  begin- 
ning. Earlier  times  surely  may  have  treated  even  the 
stronger  varieties  of  this  kind  as  troublesome  varia- 
tions in  the  sphere  of  the  normal.  On  the  other  hand, 
there  can  be  no  doubt  that,  for  instance,  the  Middle 
Ages  developed  severe  diseases  of  the  nervous  system 
in  an  almost  epidemic  way  which  is  nearly  unknown 
to  our  time. 

As  to  the  conditions  of  life  itself,  there  are  cer- 
tainly many  factors  at  work  which  secure  favorable 
influences  for  our  cerebral  activity.  The  progress  of 
scientific  hygiene  has  brought  everyone  much  nearer 


i94  PSYCHOTHERAPY 

to  a  harmonious  functioning  of  the  organism,  and  the 
progress  of  technique  has  removed  innumerable  diffi- 
culties from  the  play  of  life.  Of  course,  we  stand 
today  before  a  much  more  complex  surrounding  than 
our  ancestors  but  still  more  quickly  than  the  com- 
plexity have  grown  the  means  to  master  it.  We  have 
to  know  more:  yet  the  effort  has  not  become  greater 
since  it  has  become  easier  to  acquire  knowledge.  We 
have  to  endure  much  disturbing  noise,  and  yet  we  for- 
get how  the  sense  organs  of  our  forefathers  must 
have  been  maltreated,  for  instance,  by  flickering  light. 
We  are  in  a  rush  of  work  and  stand  in  thousandfold 
connections;  and  yet  the  neural  energy  which  is  de- 
manded is  not  large  because  a  thousand  devices  of 
our  technical  life  have  become  our  obedient  servants. 
There  is  no  nation  on  earth  which  is  more  proud  of  its 
rush  and  its  hurry  than  the  American  people;  and 
yet  what  an  abundance  of  time  is  leisurely  wasted  that 
would  have  to  be  used  for  work  if  the  country  could 
not  live  from  its  richness.  Moreover  our  life  has 
probably  become  cooler,  there  is  less  emotionalism, 
less  sentimentality,  more  business-like  attitude,  and 
that  all  means  less  inner  friction  and  excitement;  in 
public  life  too,  less  fear  of  war  and  less  religious 
struggle.  All  has  become  a  question  of  administration 
and  efficiency.  Our  time  is  certainly  not  worse  off  on 
the  score  of  neurasthenia  than  its  predecessors. 

Above  all  the  intensity  of  mental  stimuli  is  always 
relative.  The  psychologist  knows  the  experiments 
which  determine  that  we  perceive  the  difference  of 
impressions  as  alike  when  the  stimuli  are  propor- 


GENERAL  METHODS  195 

tionftl.  If  I  have  a  ten-pound  weight  in  one  hand,  I 
may  find  that  I  must  have  one  pound  more  in  the 
other  hand  to  discriminate  the  difference.  Now  if  I 
take  twenty  pounds  in  the  one  hand,  then  it  is 
not  sufficient  to  have  one  pound  more  in  the  other, 
but  I  must  have  twenty-two  pounds  in  the  other  to 
feel  a  difference,  and  if  I  take  thirty  pounds,  the 
other  weight  must  be  thirty-three.  We  feel  equal 
differences  when  the  weights  stand  in  the  same  rela- 
tion. The  man  who  owns  a  hundred  dollars  will 
enjoy  the  gain  of  five  and  regret  the  loss  of  five  just 
as  much  as  the  owner  of  a  hundred  thousand  dollars 
would  feel  the  gain  or  loss  of  five  thousand.  This 
fundamental  law  of  the  relativity  of  psychical  im- 
pressions controls  our  whole  life.  The  rush  of  stimuli 
which  might  mean  a  source  of  nervous  disturbance 
for  the  villager  whose  quiet  country  life  has  brought 
about  an  adjustment  to  faint  impressions  may  cause 
very  slight  stimulation  for  the  metropolitan  accus- 
tomed for  a  lifetime  to  the  rhythm  of  the  surround- 
ings. Yet  that  quiet  countryman  may  react  in  his 
narrow  system  not  less  when  the  modest  changes  in  his 
surroundings  provoke  him.  The  gossip  of  his  neigh- 
bor may  undermine  his  nervous  system  just  as  much 
as  a  political  fight  or  the  struggles  of  the  exchange 
that  of  the  city  man. 

The  same  holds  true  for  the  purely  intellectual 
engagements.  The  work  which  the  scholar  undertakes 
should  not  be  measured  by  the  effect  which  the  same 
appeal  to  concentrated  attention  would  make  on  the 
average  man  of  practical  life.  There,  too,  an  adjust- 


1 96  PSYCHOTHERAPY 

ment  to  the  demand  has  resulted  during  the  whole 
period  of  training  and  professional  work.  Every 
effort  should  be  estimated  with  reference  to  the  stand- 
ard of  the  particular  case.  This  relativity  of  the 
mental  reaction  on  the  demands  of  life  must  always 
be  in  the  foreground  of  the  psychotherapeutic  regime. 
Even  the  best  physicians  too  often  sin  against  this 
principle  and  accuse  the  life  which  a  man  or  woman 
leads  as  too  exhausting  and  overstraining  simply  be- 
cause it  would  be  overstraining  and  exhausting  to 
others  who  are  not  adjusted  to  that  special  standard. 
Simply  to  withdraw  a  patient  from  the  one  kind  of 
life  and  to  force  on  him  a  new  kind  with  new  stand- 
ards may  not  be  a  gain  at  all.  A  new  adjustment  be- 
gins and  smaller  differences  from  the  standard  may 
bring  about  the  same  strong  intensities  of  reaction  as 
the  large  differences  brought  before.  Complete  rest, 
for  instance,  for  a  hard  brain-worker  hardly  ought  to 
be  recommended  unless  a  high  degree  of  exhaustion 
has  come  on.  If  routine  prescriptions  are  to  be  ad- 
mitted at  all,  they  should  not  be  complete  rest  or 
complete  change  of  life  for  any  length  of  time  but  a 
continuation  of  the  life  for  which  adjustment  has  been 
learned  with  a  reasonable  reduction  of  the  demands 
and  stimulations.  The  intellectual  worker  ought  to 
decrease  his  work,  the  overbusy  society  woman  ought 
to  stay  in  bed  one  day  in  the  week,  the  man  in  the 
midst  of  the  rush  of  life  ought  to  cut  down  his  obliga- 
tions, but  probably  each  of  them  does  better  to  go  on 
than  simply  to  swear  off  altogether. 

Their  rest  ought  to  have  the  character  of  vacation ; 


GENERAL  METHODS  197 

that  means  interruptions  without  the  usual  activity 
ought  to  be  short  periods  spent  with  the  distinct  feel- 
ing that  they  are  interruptions  of  that  which  must 
last  and  that  they  are  not  themselves  to  become  last- 
ing states.  Thus  the  inner  adjustment  to  the  work 
ought  to  be  kept  up  and  ought  not  to  be  substituted 
by  a  new  adjustment  to  a  less  exacting  life.  In  this 
way  the  episode  of  the  vacation  rest  ought  to  be  in  a 
way  included  in  the  strenuous  life  almost  as  a  part 
of  its  programme.  Strenuosity  must  not  mean  an 
external  rush  with  the  gestures  of  overbusy  excite- 
ment, but  certainly  the  doctrine  of  the  lazy  life  is 
wretched  psychotherapy,  as  long  as  no  serious  illness 
is  in  question.  By  far  the  best  alteration  is,  there- 
fore, even  in  the  periods  of  interruption,  not  simply 
rest  but  new  engagements  which  awaken  new  interests 
and  stimulate  neglected  mental  factors,  disburdening 
the  overstrained  elements  of  mental  life.  The  most 
effective  agency  for  this  task  is  contact  with  beauty, 
beauty  in  nature  and  life,  beauty  in  art  and  literature 
and  music.  To  enjoy  a  landscape  ought  to  be  not 
merely  a  negative  rest  for  the  man  of  the  office  build- 
ing, and  good  literature  or  music  absorbs  the  mental 
energies  and  harmonizes  them.  In  the  second  place 
come  games  and  sport,  which  may  enter  into  their 
right  if  fatigue  can  be  avoided.  Harmonious  joy- 
ful company,  as  different  as  possible  from  the  de- 
pressing company  of  the  sanitariums,  will  add  its 
pleasantness. 

While  the  advice  of  the  physician  ought  thus  to  em- 
phasize the  positive  elements  which  work,  not  towards 


i98  PSYCHOTHERAPY 

rest,  but  toward  a  harmonious  mental  activity,  we 
must  not  forget  some  essential  negative  prescriptions. 
Everything  is  to  be  avoided  which  interferes  with 
the  night's  sleep.  Furthermore,  in  the  first  place, 
alcohol  must  be  avoided.  There  cannot  be  any  doubt 
that  alcoholic  intemperance  is  one  of  the  chief  sources 
of  brain  disturbances  and  that  the  fight  against  in- 
temperance, which  in  this  country  is  essentially  the 
fight  against  the  disgusting  saloon,  is  a  duty  of  every- 
one who  wants  to  prevent  nervous  disaster.  There 
may  and  must  be  divergence  of  opinion  as  to  the 
safest  way  to  overcome  intemperance.  The  con- 
servative physician  will  feel  grave  doubt  whether  the 
hasty  recommendation  of  complete  prohibition  is 
such  a  safe  way,  whether  it  does  not  contain  many 
conditions  of  evil,  and  whether  the  fight  against  the 
misuse  of  alcohol  will  not  be  more  successful  if  a  true 
education  for  temperance  is  accepted  as  the  next  goal. 
But  for  the  man  of  neurasthenic  constitution  and  for 
any  brain  of  weak  resistance,  the  limit  for  permissible 
alcoholic  beverages  ought  to  be  drawn  very  narrow 
and  in  such  cases  temporary  abstinence  is  usually  the 
safest  advice.  Individual  cases  must  indicate  where 
a  glass  of  light  beer  with  the  meal  or  a  glass  of  a 
mild  wine  may  be  permissible.  Strong  drinks  like 
cocktails  are  absolutely  to  be  excluded.  In  the  same 
way  a  strong  reduction  is  advisable  in  tobacco,  tea, 
and  especially  coffee.  A  complete  withdrawal  of  all 
stimulations  to  which  a  nervous  system  has  been  ac- 
customed for  years  is  not  wise,  or  at  least  mild  sub- 
stitutes ought  to  be  suggested,  but  if  coffee  can  be 


GENERAL  METHODS  199 

ruled  out  at  once,  often  much  is  gained.  In  the  same 
way  all  passionate  excitements  are  to  be  eliminated 
and  sexual  life  to  be  wisely  regulated.  An  especial 
warning  signal  is  to  be  posted  before  all  strong  emo- 
tions, and  if  the  patient  cannot  be  asked  to  leave  his 
worry  at  home,  he  can  at  least  be  asked  to  avoid  situ- 
ations which  will  necessarily  lead  to  excitement  and 
quarrel  and  possible  disappointment. 

It  is  one  of  the  surest  tests  of  psychotherapeutic 
skill  to  discriminate  wisely  whether  one  or  the  other 
of  these  features  of  general  treatment  ought  to  be 
emphasized.  They  usually  demand  more  insight  than 
specific  forms  of  psychotherapy  like  hypnotic  sug- 
gestions. These  general  efforts  are  also  much  more 
directed  against  the  disease  itself  where  the  specific 
methods  are  merely  directed  against  the  symptoms. 
The  separation  from  disturbing  surroundings,  the  re- 
duction of  engagements  and  work,  the  complete  rest, 
the  suppression  of  artificial  stimulants,  the  enjoy- 
ment of  art,  of  nature,  of  sport,  the  distractions  of 
social  life,  each  might  be  in  one  case  a  decisive  help 
and  indifferent,  perhaps  even  harmful  in  another. 
All  is  a  matter  of  choice  and  adjustment  to  the  par- 
ticular needs  in  which  all  the  personal  factors  of 
inherited  constitution,  acquired  adjustments,  social 
surroundings,  temperament,  and  education,  and  the 
probable  later  development  have  to  be  most  tact- 
fully weighed.  Yet  this  general  treatment  may  take 
and  very  often  ought  to  take  the  opposite  direction, 
not  towards  rest  but  towards  work,  not  towards  light 
distraction  but  towards  serious  effort,  not  towards 


200  PSYCHOTHERAPY 

reduction  of  engagements  but  towards  energetic 
regulation.  We  said  that  it  was  an  exaggeration  to 
blame  the  external  conditions  of  our  life,  the  tech- 
nical manifoldness  of  our  surroundings  as  the  source  of 
the  widespread  nervousness.  The  mere  complexity  of 
the  life,  the  rapidity  of  the  demands,  the  amount  of 
intellectual  effort  is  in  itself  not  dangerous  and  our 
time  is  not  more  pernicious  than  the  past  has  been; 
but  it  is  perhaps  no  exaggeration  to  say  that  our  time 
is  by  many  of  its  features  more  than  the  past  tending 
towards  an  unsound  inner  attitude  of  man. 

Much  of  the  present  civilization  leads  the  average 
man  and  woman  to  a  superficiality  and  inner  hasti- 
ness which  undermines  sound  mental  life  much  more 
than  the  external  factors.  We  look  with  a  conde- 
scending smile  at  the  old-fashioned  periods  in  which 
the  demands  of  authority  and  discipline  controlled 
the  education  of  the  child  and  after  all  the  educa- 
tion of  the  adult  to  his  last  days.  We  have  substi- 
tuted for  it  the  demand  of  freedom  with  all  its  bless- 
ings, but  instead  of  the  blessings  we  too  often  get 
all  its  vices.  A  go-as-you-please  method  characterizes 
our  whole  society  from  the  kindergarten  to  the  height 
of  life.  We  eulogize  the  principle  of  following  the 
paths  of  own  true  interest  and  mean  by  that  too  often 
paths  of  least  resistance.  Study  becomes  play,  the 
child  learns  a  hundred  things  but  does  not  learn  the 
most  important  one,  to  do  his  duty  and  to  do  it  ac- 
curately and  with  submission  to  a  general  purpose. 
The  power  of  attention  thus  never  becomes  trained, 
the  energy  to  concentrate  on  that  which  is  not  inter- 


GENERAL  METHODS 


2OI 


esting  by  its  own  appeal  is  slowly  lost,  a  flabby  super- 
ficiality must  set  in  which  is  moved  by  nothing  but  the 
personal  advantage  and  the  zigzag  impulses  of  the 
chance  surroundings.  He  who  has  never  learned 
obedience  can  never  become  his  own  master,  and  who- 
ever is  not  his  own  master  through  all  his  life  lacks 
the  mental  soundness  and  mental  balance  which  a 
harmonious  life  demands.  Flippancy  and  careless- 
ness, haphazard  interests  and  recklessness  must  result, 
mediocrity  wins  the  day,  cheap  aims  pervade  the 
social  life,  hasty  judgments,  superficial  emotions, 
trivial  problems,  sensational  excitements,  and  vulgar 
pleasures  appeal  to  the  masses.  Yellow  papers  and  < 
vaudeville  shows — vaudeville  shows  on  the  stage,  in 
the  courtroom,  on  the  political  platform,  in  the  pulpit 
of  the  church — are  welcome,  and  of  all  the  results, 
one  is  the  most  immediate,  the  disorganization  of  the 
brain  energies. 

A  sound  mind  is  a  well-organized  mind  in  which  a  \ 
controlling  idea  is  abk  to  inhibit  the  opposites  and  1 
is  in  no  danger  of  being  overrun  j>y_any  chance  intru-  / 
sionTnto~^tKie~rriinX  This  poweris  the  act  oTlttten"-  \ 

jt^-C  ~ i—  ~~ '  -—  '  ""  _-    ~  '    '  '   '  <f^.ji^-^A*^^^^^^S^^>''l\TLJ^>^Li  ^-^^j"p^^y -J^^BM^^^       ] 

tion.  An  attention  which  is  trained  and  disciplined 
can  hold  its  ideas  against  chance  impulses.  An  un- 
trained attention  is  attracted  by  everything  which  is 
loud  and  shining,  big  and  amusing.  The  trouble  is 
not  with  the  rush  and  hurry  of  the  impressions  which 
demand  our  attention;  the  trouble  is  with  our  atten- 
tion which  seeks  a  quick  change  of  new  and  ever  new 
impressions  because  it  is  not  disciplined  to  hold  firmly 
to  one  important  interest.  We  want  the  hundred 


•S 


202  PSYCHOTHERAPY 

short-cut  superficial  magazines  because  we  lack  the 
energy  to  study  one  large  volume ;  we  want  the  thou- 
sand engagements  because  we  are  not  concentrated 
enough  to  devote  ourselves  fully  to  one  ideal  task. 
The  strong  mind  may  find  its  sound  adjustment  even 
without  such  training  for  concentrated  attention 
through  obedience  and  discipline  but  the  weak  mind 
has  to  pay  the  penalty.  For  not  a  few  it  will  mean 
social  disaster.  Yet  our  society  is  sufficiently  adapted 
to  this  state  so  that  it  gives  some  good  social  chances 
to  the  superficial  too,  and  this  not  only  to  the  rich,  but 
to  those  on  every  level.  Only  the  nervous  system 
cannot  so  easily  be  adjusted  to  the  new  regime.  The 
loose  interplay  of  the  brain  cells  without  the  serious 
training  of  discipline  must  involve  disorganization 
of  the  mind-brain  system  which  may  count  often  most 
powerfully  in  those  spheres  in  which  the  mere  needs 
of  life  are  felt  the  least.  There  is  only  one  great  rem- 
edy: discipline,  training  for  concentrated  attention, 
for  a  work  in  submission  of  will  to  a  steady  purpose. 
And  psychotherapeutic  effort  will  often  demand  such 
a  training  for  work  rather  than  a  reduction  of  work 
and  rest. 

The  most  alarming  product  of  the  neglect  in 
training  is  found  in  many  of  those  retarded  children 
who  at  fifteen  show  the  intelligence  of  a  boy  of  eight. 
They  are  not  imbeciles  and  do  not  belong  in  the 
psychiatric  domain;  their  development  has  simply 
been  suspended  by  a  mistaken  education.  Of  course 
no  neglect  would  have  led  to  it  without  a  constitu' 
tional,  inherited  weakness  of  the  central  nervous  sys< 


GENERAL  METHODS  203 

tem,  but  the  weakness  would  never  have  led  to  the 
retardation  if  perhaps  a  mistaken  parental  indulgence 
had  not  allowed  a  life  without  forced  effort  and, 
therefore,  without  progress.  Even  such  extreme 
cases  may  not  show  on  the  surface.  The  boy  may 
pass  as  all  right  if  we  meet  him  at  a  ball;  only  his 
tutor  knows  the  whole  misery.  Still  less  does  the  sur- 
face view  of  many  a  grown-up  neurasthenic  alarm 
us  who  seems  to  live  a  well-ordered,  perhaps  an  envi- 
able life,  and  yet  who  suffers  the  penalty  of  a  life 
without  concentrated  effort,  really  without  anything 
to  do  in  spite  of  a  thousand  engagements.  Moreover 
this  lack  of  important  activity  may  often  be  forced 
on  our  patients.  Married  women  without  children, 
without  household  responsibilities,  and  without  inter- 
ests of  their  own  and  without  strong  nervous  constitu- 
tion will  soon  lose  the  power  of  effort  and  their  brain 
will  succumb.  A  dreary  monotony  is  dangerous  even 
for  the  worker ;  for  the  non-worker  it  may  be  ruinous. 
Yet  mere  flippant  excitement  and  superficial  en- 
tertainment is  nothing  but  a  cheap  counterfeit  of  what 
is  needed.  Voluntary  effort  is  needed,  and  this  is  the 
field  where  the  psychotherapist  must  put  in  his  most 
intelligent  effort.  There  is  no  one  for  whom  there  is 
not  a  chance  for  work  in  our  social  fabric.  The  pre- 
scription of  work  has  not  only  to  be  adjusted  to  the 
abilities,  the  knowledge,  and  social  condition,  but  has 
to  be  chosen  in  such  a  way  that  it  is  full  of  associa- 
tions and  ultimately  of  joyful  emotions.  Useless 
work  can  never  confer  the  greatest  benefits;  mere 
physical  exercises  are  therefore  psychophysically  not 


204  PSYCHOTHERAPY 

as  valuable  as  real  sport  while  physically,  of  course, 
the  regulated  exercises  may  be  far  superior  to  the  hap- 
hazard work  in  sport.  To  solve  picture  puzzles,  even 
if  they  absorb  the  attention  for  a  week,  can  never  have 
the  same  effect  as  a  real  interest  in  a  human  puzzle. 
There  is  a  chance  for  social  work  for  every  woman 
and  every  man,  work  which  can  well  be  chosen  in  full 
adjustment  to  the  personal  preference  and  likings. 
Not  everybody  is  fit  for  charity  work,  and  those  who 
are  may  be  entirely  unfitted  for  work  in  the  interest 
of  the  beautification  of  the  town.  Only  it  has  to  be 
work;  mere  automobiling  to  charity  places  or  talking 
in  meetings  on  problems  which  have  not  been  studied 
will,  of  course,  be  merely  another  form  of  the  dis- 
organizing superficiality.  The  hysterical  lady  on 
Fifth  Avenue  and  the  psychasthenic  old  maid  in  the 
New  England  country  town  both  simply  have  to  learn 
to  do  useful  work  with  a  concentrated  effort  and  a 
high  purpose.  From  a  long  experience  I  have  to 
confess  that  I  have  seen  that  this  unsentimental  rem- 
edy is  the  safest  and  most  important  prescription  in 
the  prescription  book  of  the  psychotherapist. 

There  is  one  more  feature  of  general  treatment 
which  seems  almost  a  matter  of  course,  and  yet  which 
is  perhaps  the  most  difficult  to  apply  because  it  can- 
not simply  be  prescribed :  the  sympathy  of  the  psycho- 
therapist. The  feelings  with  which  an  operation  is 
performed  or  drugs  given  do  not  determine  success, 
but  when  we  build  up  a  mental  life,  the  feelings  are 
a  decisive  factor.  To  be  sure,  we  must  not  forget  that 
we  have  to  deal  here  with  a  causal  and  not  with  a  pur- 


GENERAL  METHODS  205 

posive  point  of  view.  Our  sympathy  is  therefore  not 
in  question  in  its  moral  value  but  only  as  a  cause  of 
a  desired  effect.  It  is  therefore  not  really  our  sym- 
pathy which  counts  but  the  appearance  of  sympathy, 
the  impression  which  secures  the  belief  of  the  patient 
that  sympathy  for  him  exists.  The  physician  who, 
although  full  of  real  sympathy,  does  not  understand 
how  to  express  it  and  make  it  felt  will  thus  be  less 
successful  than  his  colleague  who  may  at  heart  remain 
entirely  indifferent  but  has  a  skillful  routine  of  going 
through  the  symptoms  of  sympathy.  The  sympa- 
thetic vibration  of  the  voice  and  skillful  words  and 
suggestive  movements  may  be  all  that  is  needed,  but 
without  some  power  of  awakening  this  feeling  of 
personal  relation,  almost  of  intimacy,  the  wisest 
psychotherapeutic  treatment  may  remain  ineffective. 
That  reaches  its  extreme  in  those  frequent  cases  in 
which  social  conditions  have  brought  about  an  emo- 
tional isolation  of  the  patient  and  have  filled  him  with 
an  instinctive  longing  to  break  his  mental  loneliness, 
or  in  the  still  more  frequent  cases  where  the  patient's 
psychical  sufferings  are  misunderstood  or  ridiculed  as 
mere  fancies  or  misjudged  as  merely  imaginary  evils. 
Again  everything  depends  upon  the  experience  and 
tact  of  the  physician.  His  sympathy  may  easily 
overdo  the  intention  and  further  reenforce  the  pa- 
tient's feeling  of  misery  or  make  him  an  hypochon- 
driac. It  ought  to  be  sympathy  with  authority  and 
sympathy  which  always  at  the  same  time  shows  the 
way  to  discipline.  Under  special  conditions  it  is  even 
advisable  to  group  patients  with  similar  diseases  to- 


2o6  PSYCHOTHERAPY 

gether  and  to  give  them  strength  through  the  natural 
mutual  sympathy;  yet  this  too  can  be  in  question 
only  where  this  community  becomes  a  starting  point 
for  common  action  and  common  effort,  not  for  mere 
common  depression.  In  this  way  a  certain  psychical 
value  must  be  acknowledged  for  the  social  classes  of 
tuberculosis  as  they  have  recently  been  instituted. 

From  sympathy  it  is  only  one  step  to  encourage- 
ment, which  indeed  is  effective  only  where  sympathy 
or  at  least  belief  in  sympathy  exists.  He  who  builds 
up  a  new  confidence  in  a  happy  future  most  easily 
brings  to  the  patient  also  that  self-control  and  energy 
which  is  the  greatest  of  helping  agencies.  The  phys- 
ical and  mental  efforts  of  the  physician  are  alike  de- 
prived of  their  best  efficiency  if  they  are  checked  by 
worry  and  fear  that  the  developments  of  the  disease 
will  be  disastrous.  As  soon  as  new  faith  in  life  is 
given,  and  given  even  where  a  sincere  prognosis  must 
be  a  sad  one,  a  great  and  not  seldom  unexpected  im- 
provement is  secured.  There  is  no  doubt  that  the 
routine  physician  is  doing  by  far  too  little  in  these 
respects.  His  instinctive  feeling  that  disease  is  a 
causal  process,  and  that  he  should  therefore  keep 
away  from  the  purposive  attitude,  leads  him  too  easily 
to  a  dangerous  narrowness.  He  treats  disease  as  if 
it  were  an  isolated  process  and  overlooks  the  thou- 
sandfold connections  in  which  the  nervous  system 
stands  with  the  patient's  whole  life  experience  in  past 
and  future.  The  physician  is  thus  too  easily  inclined 
to  underestimate  the  good  which  may  come  in  the 
fight  against  disease  from  the  ideas  and  emotions 


GENERAL  METHODS  207 

which  form  the  background  of  the  mind  of  the  pa- 
tient. Even  if  the  disease  cannot  be  vanquished,  the 
mental  disturbances  which  result  from  it,  the  pains 
and  discomforts,  may  be  inhibited,  as  soon  as  hopes 
and  joyful  purposes  gain  a  dominating  control  of  the 
mind.  The  nervous  patient  often  needs  a  larger  hold 
upon  life,  while  the  routine  prescriptions  may  too 
easily  reduce  that  hold  by  fixing  the  attention  on  the 
symptoms. 

Here  then  is  the  right  place  for  the  moral  appeal 
and  the  religious  stimulation.  How  psychotherapy  is 
related  to  the  church  will  interest  us  later.  At  this 
moment  morality  and  religion  are  for  us  not  inspira- 
tions but  medicines.  But  from  such  a  causal  point  of 
view,  we  should  not  underestimate  the  manifold  good 
which  can  come  from  the  causal  effect  of  religious 
and  ethical  ideas.  Those  faith  curists  who  bring 
mutual  help  by  impressing  each  other  with  the  beauty 
and  goodness  of  the  world  really  bring  new  strength 
to  the  wavering  mind;  and  the  most  natural  channel 
for  religious  help  remains,  of  course,  the  word  of  the 
minister  and  the  own  prayer.  Religion  may  work 
there  causally  in  a  double  way.  The  own  personality 
is  submerging  into  a  larger  all-embracing  hold  and 
thus  inhibits  the  small  cares  and  troubles  of  merely 
personal  origin.  The  consciousness  sinks  into  God, 
a  mental  process  which  reaches  its  maximum  in  mys- 
ticism. The  haphazard  pains  of  the  personality  dis- 
appear and  are  suppressed  by  the  joy  and  glory  of 
the  whole.  This  submission  of  will  under  a  higher 
will  and  its  inhibitory  effect  for  suppression  of  dis- 


208  PSYCHOTHERAPY 

turbing  symptoms  must  be  wonderfully  reenforced  by 
the  attitude  of  prayer.  Even  the  physiological  con- 
ditions of  it,  the  clasping  of  the  hands,  the  kneeling, 
and  monotonous  sounds  reenforce  this  inhibition  of 
the  insignificant  dissatisfactions.  On  the  other  hand, 
contact  with  the  greater  will  must  open  the  whole 
reservoir  of  suppressed  energies,  and  this  outbreak 
of  hidden  forces  may  work  towards  the  regeneration 
of  the  whole  psychophysical  system.  Neglected  func- 
tions of  the  brain  become  released  and  give  to  the 
mind  an  energy  and  discipline  and  self-control  and 
mastery  of  difficulties  which  restitutes  the  whole 
equilibrium,  and  with  the  equilibrium  comes  a  new 
calmness  and  serenity  which  may  react  almost  miracu- 
lously on  the  entire  nervous  system  and  through  it  on 
the  whole  organism  and  its  metabolism. 

Seen  from  a  causal  point  of  view,  however,  there  is 
no  miracle  in  it  at  all.  On  the  contrary,  it  is  a  natural 
psychophysical  process  which  demands  careful  super- 
vision not  to  become  dangerous.  It  is  not  the  value 
of  the  religion  which  determines  the  improvement, 
and  it  is  not  God  who  makes  the  cure;  or  to  speak 
less  irreligiously,  the  physicia'n  ought  to  say  that  if  it 
is  God  who  cures  through  the  prayer,  it  is  not  less 
God  who  cures  in  other  cases  through  bromide  and 
morphine,  and  on  the  other  side  just  as  God  often  re- 
fuses to  cure  through  the  prescribed  drugs  of  the  drug 
store,  God  not  less  often  refuses  to  cure  through 
prayer  and  church  influence.  But  the  real  standpoint 
of  the  physician  will  be  to  consider  both  the  drugs 
and  the  religious  ideas  merely  as  causal  agencies  and 


GENERAL  METHODS  209 

to  try  to  understand  the  conditions  of  their  efficiency 
and  the  limits  which  are  set  for  them.  From  such  a 
point  of  view,  he  will  certainly  acknowledge  that 
submission  to  a  greater  power  is  a  splendid  effect  of 
inhibition  and  at  the  same  time  a  powerful  effect  for 
the  stimulation  of  unused  energies ;  but  he  will  recog- 
nize also  that  the  use  of  those  silent  energies  is  not 
without  dangers. 

Certainly  nature  has  supplied  us  with  a  reservoir 
of  normally  unused  psychophysical  strength,  to  which 
we  may  resort  just  as  the  tissues  of  our  body  may 
nourish  us  for  a  few  days  when  we  are  deprived  of 
food,  but  such  supply,  which  in  exceptional  cases  may 
become  the  last  refuge,  cannot  be  used  without  a  seri- 
ous intrusion  and  interference  with  the  normal  house- 
hold of  mind  and  body.  To  extract  these  lowest 
layers  of  energies  may  mean  for  the  psychophysical 
system  a  most  exhausting  effort  which  may  soon  bring 
a  reaction  of  physical  and  nervous  weakness.  The 
chances  are  great  that  such  a  religious  excitement,  if 
it  is  really  to  have  a  deep  effect,  may  go  over  into  a 
mystic  fascination  which  leads  to  hysteria  or  into  an 
exhausting  eruption  of  energies  which  ends  in  neuras- 
thenic after-effects.  The  immediate  successes  of  the 
strong  religious  influence  on  the  weakened  nervous 
system,  especially  on  the  nervous  system  of  a  weak  in- 
herited constitution,  are  too  often  stage  effects  which 
do  not  last.  From  a  mere  purposive  point  of  view, 
they  may  be  complete  successes.  They  may  have 
turned  the  immoral  man  into  a  moral  man,  the  skeptic 
into  a  believer,  but  the  physician  cannot  overlook 


2io  PSYCHOTHERAPY 

that  the  result  may  be  a  moral  man  with  a  crippled 
nervous  system,  a  believer  with  psychasthenic  symp- 
toms. From  the  point  of  view  of  the  church,  there 
cannot  be  too  much  religion ;  from  a  therapeutic  point 
of  view,  religion  works  there  like  any  other  nervous 
remedy  of  which  five  grains  may  help  and  fifty  grains 
may  be  ruinous. 

Moreover  this  power  of  inhibiting  the  little  trou- 
bles of  the  body  and  of  bringing  to  work  and  effective- 
ness the  deepest  powers  of  the  mind  belongs  not  less 
to  any  other  important  idea  and  overpowering  pur- 
pose. The  soldier  in  battle  does  not  feel  the  pain  of 
his  wound,  and  in  an  emergency  everybody  develops 
powers  of  which  he  was  not  aware.  The  same  effect 
which  religion  produces  may  thus  be  secured  by  any 
other  deep  interest :  service  for  a  great  human  cause, 
enthusiasm  for  a  gigantic  plan,  even  the  prospect  of  a 
great  personal  success..  Thus  in  a  psychotherapeutic 
system,  religion  has  only  to  take  its  place  in  line  with 
many  other  efforts  to  inhibit  the  feeling  of  misery  and 
to  reenforce  will  and  self-control  by  submission  under 
a  greater  will.  That  in  the  case  of  religion  this  sub- 
mission, from  an  entirely  different  purposive  point  of 
view,  also  has  a  moral  and  religious  value,  has  in 
itself  no  relation  to  the  question  of  its  therapeutic 
character.  It  ought  not  to  lead  to  any  one-sided  pref- 
erence, inasmuch  as  religiously  indifferent  agencies 
may  be  in  the  particular  case  a  more  reliable  means 
of  improvement.  Moreover  the  psychological  symp- 
toms are,  after  all,  only  a  fraction  of  the  disease  and 
very  different  bodily  factors,  digestion  and  nutrition, 


GENERAL  METHODS  211 

heart  and  lungs  and  sexual  organs  may  be  most  inti- 
mately connected  with  the  disturbance  of  the  equi- 
librium. Medicine  today  no  longer  believes  that  hys- 
teria originates  in  the  diseases  of  the  uterus  or  that 
neurasthenia  necessarily  results  from  insufficiencies 
of  the  stomach,  but  it  would  be  a  graver  mistake  to 
believe  that  mental  factors  alone  decide  the  progress 
of  the  disease,  however  prominent  the  mental  symp- 
toms may  be  in  it. 

From  the  physician's  encouragement  and  the  min-* 
ister's  influence  towards  new  faith  in  life,  a  short 
way  leads  to  the  influence  of  suggestion.  It  is  on  the 
whole  the  way  which  leads  from  the  general  psycho- 
therapeutic  treatment  to  the  specific  one  directed 
against  particular  symptoms. 


IX 


OF  course  there  is  no  abrupt  division  between 
special  and  general  methods.  Yet  the  different 
tendency  is  easily  recognized,  if  we  turn  only, 
for  instance,  from  the  mere  sympathy  and  encourage- 
ment to  the  method  of  reasoning  with  the  patient 
about  the  origin  of  his  special  complaint.  Just  now 
the  medical  profession  moves  along  this  line  a  great 
deal.  Of  course  no  well-trained  psychotherapist  will 
make  the  blunder  of  arguing  with  the  insane.  To 
dispute  by  argument  with  the  paranoiac  and  to  try  to 
convince  him  would  not  be  only  without  success,  but 
easily  irritating.  This  does  not  mean  that  the  not 
less  amateurish  way  ought  to  be  taken  of  accepting 
his  delusions  and  appearing  to  be  in  full  agreement 
with  him.  A  tactful  middle  way,  preferably  a  dis- 
ciplinary ignoring  atttitude,  ought  to  be  taken.  But 
it  is  entirely  different  with  the  mental  states  of  the 
psychasthenic.  The  mere  statement  and  objective 
proof  that  his  obsession  is  based  on  an  illusion  would 
be  ineffective.  He  knows  that  himself,  but  he  may 
take  the  disturbance  as  the  beginning  of  a  brain  dis- 
ease, as  a  form  of  insanity,  as  a  lasting  damage  which 
lies  entirely  beyond  his  control.  Now  the  physician 

212 


SPECIAL  METHODS  213 

explains  to  him  how  it  all  came  about.  He  shows  to 
him  that  the  symptoms  resulted  merely  from  autosug- 
gestion or  are  the  aftereffects  of  a  suggestion  from 
without  or  of  a  forgotten  emotional  experience  of 
the  past.  That  is  a  new  idea  to  the  patient  and  one 
which  changes  the  aspect  and  may  have  an  inhibitory 
influence. 

Of  course,  the  patient  does  not  accept  the  explana- 
tion at  once.  He  feels  sure  that  he  is  not  accessible 
to  suggestion  and  that  he  has  least  of  all  a  tendency 
to  autosuggestions,  but  the  skillful  psychotherapist 
will  find  somewhere  an  opening  for  the  entering 
wedge.  He  may  develop  to  the  patient  the  modern 
theories  of  the  origin  of  neurotic  disturbances,  all 
with  entire  sincerity  and  yet  all  shaped  in  a  way 
which  gives  to  the  special  case  an  especially  harmless 
appearance.  He  may  even  enter  into  experimental 
proof  that  the  patient  is  really  accessible  to  autosug- 
gestions. A  very  simple  scheme  for  instance  is  to 
put  some  interesting  looking  apparatus  with  a  few 
metal  rings  on  the  fingers  of  the  subject  and  connect 
it  with  a  battery  and  electric  keys.  The  key  is  then 
pushed  down  in  view  of  the  patient  and  he  is  to  indi- 
cate the  time  when  and  the  place  where  he  begins  to 
feel  the  galvanic  current.  The  feeling  will  come  up 
probably  very  soon  in  the  one  or  the  other  finger,  and 
as  soon  as  he  feels  sure  that  the  sensation  is  present, 
the  physician  can  show  him  that  there  was  no  con- 
nection in  the  wires,  that  the  whole  galvanic  sensa- 
tion was  the  result  of  suggestion. 

Such  a  method  demands  patience  and  good  will. 


2i4  PSYCHOTHERAPY 

The  prejudices  and  deeply-rooted  hypochondriac 
ideas,  foolish  theories  of  the  patient  and  pessimistic 
emotions  which  have  become  habitual,  must  be  re- 
moved piece  by  piece  until  the  central  symptoms 
themselves  can  be  undermined  and  explored.  It 
often  takes  hours  of  careful  and  fatiguing  reasoning, 
in  which  at  any  time  the  patient  may  suddenly  slip 
back  to  his  old  ideas.  Yet  if  the  explanatory  argu- 
ments have  once  succeeded  in  making  the  patient  him- 
self believe  firmly  that  his  whole  trouble  resulted 
from  suggestion  only,  the  inhibitory  effect  of  this 
idea  may  be  an  excellent  one.  The  only  serious  de- 
fect of  the  method  is  that  it  often  does  not  work. 
The  credit  which  neurologists  of  today  give  to  its 
effectiveness  seems  to  me  much  too  high.  Even 
slight  neurasthenic  and  psychasthenic  disturbances  re- 
main too  often  in  complete  power  when  the  patient 
is  fully  convinced  that  they  originated  with  an  emo- 
tional excitement  which  has  long  since  lost  its  feeling 
value  or  that  it  resulted  from  a  chance  suggestion 
picked  out  from  indifferent  surroundings.  The  pa- 
tient knows  it  and  yet  goes  on  suffering  from  the 
fruitless  fight  of  his  will  against  the  intruder. 
Where  mere  reasoning  is  entirely  successful,  I  am  in- 
clined to  suspect  that  an  element  of  suggestion  has 
always  been  superadded.  The  authority  of  the  phy- 
sician has  created  a  state  of  reenforced  suggestibility 
in  which  the  argument  convinces,  not  by  its  logic  but 
by  its  impressiveness. 

This  element  of  suggestion  is  quite  obvious  when 
the  argument  takes  the  form  of  persuasion,  a  psycho- 


SPECIAL  METHODS  215 

therapeutic  method  which  has  found  its  independent 
development.  Whoever  seeks  to  persuade  relies  on 
the  mental  fringe  of  his  propositions.  The  idea  is 
not  to  work  by  its  own  meaning  but  by  the  manner  of 
its  presentation,  by  its  impressiveness,  by  the  author- 
ity, by  the  warmth  of  the  voice,  by  the  sympathy 
which  stands  behind  it,  by  the  attractiveness  with 
which  it  is  offered,  by  the  advantages  which  are  in 
sight.  Thus  persuasion  relies  on  personal  powers 
to  secure  conviction  where  the  logic  of  the  argument 
is  insufficient  to  overcome  contradictions.  But  just 
for  that  reason  persuasion  is  after  all  only  a  special 
kind  of  suggestion. 

Other  methods  work  on  the  same  basis.  Promi- 
nent among  them  is  the  psychotherapeutic  effect  of  a 
formal  assurance.  The  psychotherapist  assures  the 
patient  that  he  will  sleep  the  next  night  or  that  the 
pain  will  disappear  or  that  he  will  be  able  to  walk 
with  such  firmness  that  the  counter-idea  is  under- 
mined. It  depends  on  the  type  of  patient  whether 
such  suggestions  of  belief  work  better  when  it  is  as- 
sured with  an  air  of  condescension,  spoken  with  an 
authority  which  simply  ignores  every  possible  con- 
tradiction, or  with  an  air  of  sympathy  and  hope. 
Experience  shows  that  it  is  favorable  to  connect  such 
assurance  with  the  entrance  of  a  definite  signal. 
'  You  will  sleep  to-night  when  the  clock  strikes  ten," 
'  The  pain  will  disappear  when  you  enter  the  door 
of  your  house,"  or  perhaps,  "  Read  this  letter  three 
times  quietly  in  a  low  voice,  and  at  the  end  of  the 
third  reading  your  fear  will  suddenly  stop."  Psy- 


2i  6  PSYCHOTHERAPY. 

chological  insight  will  further  decide  whether  it  is 
wiser  in  the  particular  case  to  assure  the  patient  of 
the  resulting  effect  or  rather  of  the  power  to  bring 
about  the  effect.  With  some  people,  it  works  better 
to  insist  that  the  result  will  happen,  with  others  to 
promise  that  they  themselves  can  secure  it ;  in  the  one 
case  they  feel  themselves  as  passive  instruments,  in 
the  other  as  real  actors.  To  some  hysterics,  it  is 
better  to  say :  "  You  will  walk,"  to  others,  "  You  can 
walk." 

This  belief  in  the  future  entrance  of  a  change  fre- 
quently demands  an  artificial  reenforcement.  There 
belongs  first  the  application  of  external  factors  which 
awaken  in  the  background  of  the  mind  the  support- 
ing idea  that  something  has  been  changed  in  the 
whole  situation  or  that  some  helpful  influence  has 
made  the  improvement  possible.  Medicines  of  col- 
ored and  flavored  water,  applications  of  electric  in- 
struments without  currents,  in  extreme  cases  even  the 
claptrap  of  a  sham  operation  with  a  slight  cut  in  the 
skin,  may  touch  those  brain  cells  which  words  alone 
cannot  reach  with  sufficient  energy  and  may  thus  se- 
cure the  desired  psychophysical  effect.  The  patient 
who  by  merely  mental  inhibition  has  lost  his  voice  for 
weeks  may  get  it  back  as  soon  as  the  physician  has 
looked  into  his  larynx  with  a  mirror  and  has  held  an 
electrode  without  battery  connection  on  the  throat. 
Another  way  of  helping  by  make-believe  methods  is 
to  give  the  impression  that  a  decided  improvement  is 
noticeable.  The  uneducated  patient  believes  it  easily 
when  the  physician  at  his  very  entrance  into  the  office 


SPECIAL  METHODS  217 

expresses  his  surprise  about  the  external  symptoms  of 
a  change  for  the  better,  perhaps  seen  in  the  color  of 
the  skin  or  the  shading  of  the  iris  in  the  eye  and  re- 
affirmed by  some  pseudotests  of  the  muscle  reflexes. 
All  that  is  not  very  edifying  and  the  decent  physician, 
who  justly  feels  somewhat  dragged  down  to  the  level 
of  the  quack  in  applying  such  means  frequently,  will 
abstain  from  them  wherever  possible.  He  knows 
that  in  the  long  run,  even  the  psychasthenics  are  best 
treated  with  frankness  and  sincerity  and  he  will  there- 
fore only  in  exceptional  cases  resort  to  such  short-cut 
treatment  by  making  believe.  Yet  that  it  is  some- 
times almost  the  only  way  to  help  the  patient  cannot 
be  denied. 

A  neater  way  to  secure  the  sufferer's  belief  in  the 
possibility  of  a  cure  is  by  securing  the  desired  effect 
at  least  once  through  little  devices.  As  soon  as  it  is 
once  reached,  the  patient  knows  that  it  can  be  reached 
and  this  knowledge  works  as  a  suggestion.  The 
hysteric  who  cannot  speak  when  he  thinks  of  his 
words,  or  who  cannot  walk  when  he  thinks  of  his 
legs,  may  by  the  skillful  physician  be  brought  to  a 
few  words  or  steps  before  he  himself  is  aware  of  it 
by  completely  turning  his  attention  to  something  else 
and  producing  the  stimulus  toward  the  movement  in 
a  reflex-like  way.  Still  more  successful  is  the  effort 
to  resolve  the  inhibited  action  into  its  component 
parts  and  to  show  to  the  patient  who  cannot  perform 
the  action  as  a  whole  that  he  can  go  through  the  parts 
of  it  after  all.  As  soon  as  he  has  passed  through  a 
few  times,  a  new  tactual-visual  image  of  the  whole 


1 1 8  PSYCHOTHERAPY 

complex  is  secured  for  his  consciousness  and  this 
image  works  then  as  a  new  cue  for  the  entire 
voluntary  action,  overcoming  the  associated  counter- 
idea. 

Another  excellent  way  to  overpower  a  troublesome 
idea  or  impulse  or  emotion  is  to  reenforce  the  op- 
posite idea  by  breaking  open  the  paths  for  its  motor 
expression.  The  effort  to  hold  the  counter-idea  be- 
fore consciousness  may  be  unsuccessful  so  long  as  it 
is  only  an  idea  which  tries  in  vain  to  produce  any 
motor  effect;  but  if  the  action  itself  has  been  re- 
peatedly gone  through,  the  idea  will  find  it  easier  to 
settle  and  it  becomes  vivid  in  proportion  to  the  open- 
ness of  the  channels  of  motor  discharge.  This  holds 
true  even  for  emotional  states.  A  certain  word  per- 
haps picked  up  by  the  psychasthenic  in  a  particular 
experience  may  produce  whenever  it  is  seen  a  shock 
and  a  depressing  emotion.  If  we  ask  the  patient  to 
go  artificially  through  the  movements  which  express 
joy  and  hilarity,  make  him  intentionally  grin  and 
open  wide  the  eyes  and  expand  the  arms  and  inhale 
deeply,  and  after  training  this  movement  complex  of 
joyful  expression,  speak  the  dreaded  word  at  the 
height  of  the  movement  a  new  feeling  combination 
clusters  about  the  sound  and  may  overcome  the 
antagonism.  Sometimes  you  will  give  to  the  de- 
sirable idea  sufficient  strength  by  mere  repetition, 
sometimes  you  force  the  attention  better  by  unusual 
accentuation,  connecting  the  suggestion  with  a  kind 
of  shock.  From  here  it  is  only  one  step  to  the  sug- 
gestion in  the  form  of  a  sharp  order  which  breaks 


SPECIAL  METHODS  219 

down  the  resistance  just  by  its  suddenness  and  loud- 
ness,  supported  perhaps  by  a  quick  arm  movement 
which  gives  a  cue  for  imitative  reflexes.  In  the  case 
of  a  youngster  even  a  slap  may  add  to  the  nervous 
shock;  also  a  sudden  clapping  of  the  hands  may  favor 
effectiveness  of  the  suggestive  order. 

Often  it  is  wise  to  give  the  suggestion,  not  from 
without  but  to  prescribe  it  in  the  form  of  autosug- 
gestions. For  instance,  advise  the  patient  not  only 
to  have  the  good  will  and  intention  of  suppressing  a 
certain  fixed  idea  or  by  producing  a  certain  inhibited 
impulse  but  to  speak  to  himself  in  an  audible  voice, 
every  morning  and  every  evening,  saying  that  he  will 
overcome  it  now.  Here,  too,  the  autosuggestion 
may  become  effective  by  the  frequency  of  the  repeti- 
tion or  by  the  urgency  of  the  expression  or  by  the 
accompanying  motor  reactions.  As  a  matter  of 
course  any  associations  which  reenforce  the  idea  may 
be  used  for  assistance.  Especially  near-lying  is  the 
appeal  to  the  man's  conscience,  but  just  such  associa- 
tions which  touch  the  idea  of  the  own  personality  and 
its  deepest  layers  of  feelings  are  always  risky.  They 
may  touch  and  stir  up  old  memories  which  interfere 
with  success  or  they  may  awaken  a  feeling  of  con- 
trast between  duty  and  fulfillment  which  may  disturb 
the  whole  equilibrium.  If  the  physician  knows  that 
the  good-will  of  the  patient  is  insufficient  to  overcome 
the  pathological  disturbance,  he  ought  not  to  make 
him  feel  ashamed  or  guilty,  and  that  not  only  for 
moral  reasons  but  also  for  strictly  psychotherapeutic 
reasons. 


220  PSYCHOTHERAPY 

In  certain  easily  recognizable  cases,  it  is  essential 
to  give  the  suggestion  with  avoidance  of  any 
emphasis,  only  as  a  hint,  passing  as  if  the  suggestion 
almost  slipped  from  the  tongue  of  the  doctor  without 
his  real  intention.  The  hysteric  who  is  resisting  the 
suggestion  which  is  intentionally  given  to  her  is  some- 
times surprisingly  trapped  by  a  half-hidden  sug- 
gestion, perhaps  not  spoken  to  the  patient  herself  at 
all  but  spoken  in  a  low  voice  to  a  colleague  in  the 
room.  Sometimes  we  have  to  trick  those  who  suffer 
by  "  negativism,"  that  is  by  an  obstinacy  which  exag- 
gerates that  of  the  ordinary  stubborn  man.  In  such 
cases  the  suggestion  not  to  perform  an  action  works 
best  if  we  want  the  action  performed.  There  is  hardly 
an  end  to  the  list  of  such  methods  for  bringing  be- 
liefs and  attitudes  with  suggestive  power  to  the  mind 
of  the  sufferer.  Definitely  to  describe  the  conditions 
under  which  the  one  or  the  other  form  ought  to  be 
applied  would  be  no  wiser  than  to  tell  a  statesman 
what  steps  are  to  be  taken  in  every  possible 
diplomatic  situation.  The  instinctive  selection  of  the 
right  means  among  the  many  possible  ones  char- 
acterizes both  the  true  statesman  and  the  true  doctor. 

So  far  we  have  spoken  only  about  the  character  of 
the  suggestion,  presupposing  that  the  receiver  re- 
mains in  his  natural  state.  This  presupposition  is 
certainly  often  entirely  correct,  but  as  far  as  it  is 
correct,  the  results  of  the  suggestion  vary  greatly 
with  the  different  individuals.  On  the  whole,  we 
might  say  that  such  suggestions  given  to  the  subject 
in  his  normal  state  are  effective  only  when  the  subject 


SPECIAL  METHODS  221 

is  by  nature  a  suggestible  being.  In  considering  the 
psychology  of  suggestion,  we  recognized  at  once  that 
the  degree  of  natural  suggestibility  varies  excessively. 
The  non-suggestible  mind  is  only  to  a  slight  degree 
influenced  by  any  of  these  proposed  forms  of  sug- 
gestion as  long  as  the  suggestibility  itself  is  not 
heightened.  To  be  sure,  the  question  whether  the 
person  is  suggestible  by  nature  or  not  cannot  be 
settled  simply  by  his  own  impression.  Many  of  the 
most  suggestible  persons  believe  firmly  that  they  are 
superior  to  any  suggestive  influence. 

To  bring  suggestions  to  greater  effectiveness  and 
to  exert  their  influence  practically  upon  every  possible 
subject,  we  have  thus  not  only  to  give  suggestions  or 
to  advise  autosuggestion  but  in  both  cases  we  have 
to  secure,  especially  for  the  naturally  less  suggestible 
patients,  a  somewhat  heightened  suggestibility.  Yet 
no  one  can  overlook  that  some  of  the  methods  which 
we  described  have  in  themselves  the  tendency  to  re- 
enforce  the  mental  suggestibility.  Those  methods  of 
emphasis  and  order,  of  assurance  and  make-believe, 
of  practical  training  and  of  awakening  counter-ideas, 
of  persuasion  and  even  of  reasoning,  wherever  they 
are  in  a  high  degree  successful  probably  always  gain 
a  certain  part  of  their  success  by  the  increased  sug- 
gestibility which  the  whole  situation  brings  with  it. 

This  reinforcement  of  the  psychophysical  readi- 
ness for  suggestions  results  indeed  quite  directly  both 
from  expectation  of  the  unknown  and  of  the  half-way 
mysterious,  and  from  the  confidence  in  the  doctor. 
Of  course  it  can  work  very  differently.  The  expec- 


222  PSYCHOTHERAPY 

taticn  can  upset  the  nervous  system  and  produce  un- 
rest instead  of  suggestibility  and,  instead  of  con- 
fidence, the  patient  may  feel  that  discouraging  diffi- 
dence which  settles  easily  upon  those  who  have  tried 
one  fashionable  physician  after  another.  But  where 
there  is  real  confidence,  based  perhaps  on  the  fame  of 
the  doctor  and  on  the  reports  of  his  powerful  achieve- 
ments, there  the  conditions  for  effective  suggestions 
are  greatly  strengthened.  Still  better  is  it  if  this 
confidence  in  the  man  is  combined  with  a  sincere  hope 
for  recovery.  To  lie  down  on  a  lounge  on  which 
hundreds  have  been  cured  fascinates  the  imagination 
sufficiently  to  give  to  every  suggestion  a  much  better 
chance  to  overcome  the  counter-idea.  The  expecta- 
tion that  something  wonderful  will  happen  can  even 
produce  an  almost  hypnoid  state.  The  effect  will  be 
the  greater,  the  less  the  barriers  of  systematic  knowl- 
edge hinder  the  entrance  of  suggested  ideas.  The 
uneducated  will  on  the  whole  offer  less  resistance  to 
suggestions,  just  as  superstitions  find  the  freest  play 
in  the  minds  of  the  untrained.  It  is  not  by  chance 
that  the  earlier  epidemics  of  pathological  suggesti- 
bility have  on  the  whole  disappeared  with  the  better 
popular  education.  In  a  similar  way  work  fatigue 
and  exhaustion.  The  resistance  has  grown  weaker, 
the  suggested  idea  goes  automatically  into  activity. 

Skillful  artificial  means  can  still  surpass  the  effect 
of  these  natural  conditions.  Here  belongs  every- 
thing which  accentuates  the  authority  and  dignity  of 
the  originator  of  the  suggestion.  The  psycho- 
logically trained  physician  has  no  difficulty  in  height- 


SPECIAL  METHODS  223 

ening  the  effect  by  simple  surprises,  if  he  cares  for 
such  tricks.  If  the  patient  for  whom  a  mental  treat- 
ment is  recognized  as  necessary  shows  himself  too 
skeptical  to  submit  to  the  powers  of  the  psycho- 
therapist, such  captivation  of  his  belief  can  easily  be 
secured.  Let  the  man  perhaps  fixate  a  penny  on  the 
table  with  his  right  eye,  while  the  left  is  closed  and 
you  show  him  that  you  can  make  another  penny  sud- 
denly disappear  when  you  move  it  a  certain  distance 
to  the  right  and  appear  again  when  you  move  it  still 
further.  As  the  man  has  never  heard  of  the  blind 
spot  in  the  retina,  he  accredits  you  with  a  special 
power.  Many  similar  psychological  illusions  can  well 
be  used  to  prepare  the  mind  for  unsuspected  healing 
powers. 

Still   stronger  is   the  effect  of  personal   contact.      /\ 
The   psychophysiology   of   love   indicates   the   most      \jr 
complex  influence  which  contact  sensations  have  on        o 
the  whole  nervous  system  and  especially  on  the  vaso- 
motor  apparatus  of  the  body.     Probably  such  vaso-         ^ 
motor  effect  enters  in,  changing  the  blood  circulation 
in  the  brain,  when  a  personal  contact  between  the 
transmitter  and  receiver  of  the  suggestion  is  brought 
about.     If  the  physician's  hand  rests  quietly  on  the 
forehead  of  the  patient  who  lies  with  closed  eyes,  or         Q. 
if  he  holds  for  a  long  while  the  hand  of  the  patient, 
he  may  secure  a  nervous  repose  and  submission  which 
gives  to  the  suggestions  the  most  fertile  soil.     Need- 
less to  say  that  here  again  everything  depends  upon 
the  accessories.     An  unsympathetic  doctor  may  be 
entirely  powerless  where  his  neighbor  has  complete 


224  PSYCHOTHERAPY 

success.  Neither  a  lifeless  hand  nor  an  agitating 
one  will  bring  the  desired  repose,  neither  a  cold  nor  a 
rough  one.  There  must  be  strength  and  energy  and 
even  discipline,  and  yet  sympathy  in  the  pressure  of 
the  fingers.  Again  a  psychologically  different  effect 
and  yet  one  often  to  be  preferred  results  from  mild 
stroking  movements,  the  stroke  always  to  be  repeated 
in  the  same  direction,  never  up  and  down.  The 
slow  change  in  the  position  of  the  tactual  sensations 
evidently  produces  a  rather  strong  influence  on  the 
equilibrium  of  nervous  impulses,  and  here  again  vaso- 
motor  reflexes  seem  to  arise  easily.  Another  variety 
of  such  bodily  influences  is  given  by  artificial  changes 
of  the  positions,  for  instance  by  bending  the  head  of 
the  subject  backward  while  the  eyes  are  closed.  It 
may  be  that  a  certain  lack  of  balance  sets  in  in  which 
the  self-equilibrium  is  disturbed  and  an  external  in- 
fluence can  thus  more  easily  get  control  of  the  psy- 
chophysical  system.  Again  a  certain  monotony  of 
speaking  may  easily  add  to  the  increase  of  the  sug- 
gestibility. 

Everyone  knows  that  another  most  fruitful  cause  of 
this  change  is  any  mystic  inspiration,  any  emotion  in 
which  the  individual  feels  himself  in  contact  with 
something  higher  or  larger  or  stronger.  Of  course, 
the  church  can  secure  this  effect  easily,  and  here  again 
the  maximum  will  be  reached  if  a  bodily  contact  with 
the  symbol  of  religious  exaltation  can  be  established. 
The  patient  who  can  touch  the  relics  of  the  saints  or 
bathe  in  the  waters  of  Lourdes  or  at  least  feel  on  his 
forehead  the  hand  of  the  minister,  is  wrought  up  to 


SPECIAL  METHODS  225 

a  state  of  suggestibility  which  makes  suggestions 
easily  effective.  The  objective  value  of  religion 
again  has  nothing  to  do  with  it,  as  exactly  the  same 
effect  can  result  from  the  most  barbarous  superstition. 
The  amulets  of  a  gypsy  might  secure  the  same  re- 
setting of  the  psychophysical  system  which  the  most 
sacred  symbols  awaken,  and  even  many  an  educated 
person  is  unable  to  cross  the  threshold  of  a  palmist 
or  an  astrologist,  or  to  attend  the  performance  of  a 
spiritist,  or  to  sit  down  with  a  purchasable  trance 
medium  without  feeling  an  uncanny  mental  state 
which  is  objectively  characterized  by  an  increased 
suggestibility.  But  finally,  the  same  effect  sets  in 
when  the  symbols  of  other  emotional  spheres  are  ap- 
plied, perhaps  for  the  patriotic  soldier  the  flag  of  his 
country. 

All  the  states  of  increased  suggestibility  which  we 
have  characterized  so  far  still  remain  within  the  limit 
of  normal  wakefulness.  We  may  turn  now  to  the 
methods  of  the  psychotherapist  which  produce  in  the 
interest  of  the  suggestions  an  artificial  state.  How- 
ever we  have  no  right  superficially  to  claim  that  the 
effectiveness  of  the  suggestions  is  always  greater  in 
such  unnatural  states.  On  the  contrary,  we  know 
that  sometimes  well  applied  suggestions  work  on 
wideawake  persons  with  increased  suggestibility  more 
strongly  than  on  hypnotized  subjects.  Here  even 
the  instinct  of  the  experienced  physician  may  easily 
go  astray,  and  it  may  need  practical  tests  to  find  out 
which  way  will  be  the  most  accessible  to  the  par- 
ticular case.  Often  a  certain  role  belongs  even  to 


226  PSYCHOTHERAPY 

natural  sleep.  It  cannot  be  denied  that  some  people 
can  be  influenced  to  some  degree  by  words  spoken  to 
them  during  sleep.  Most  adults  either  wake  up  or 
show  no  signs  of  influence  beyond  effects  on  their 
dreams.  But  some  absorb  especially  whispered 
words  in  such  a  way  that  their  power  becomes  evident 
after  the  waking  of  the  sleeper.  Much  more  is  this 
true  of  children.  A  suggestion  to  give  up  vicious 
habits,  perhaps  in  the  sexual  sphere,  or  to  speak 
fluently  and  no  longer  stammer  may  thus  be  bene- 
ficial. Yet  the  danger  of  this  method  is  not  small 
and  extensive  use  of  it  is  certainly  not  advisable. 
The  more  easily  it  can  be  carried  into  every  bed- 
chamber and  can  thus  give  to  every  mother  and  nurse 
the  tools  of  a  rather  powerful  therapy,  the  more  a 
danger  signal  ought  to  be  displayed.  Interference 
with  the  natural  sleep  by  outer  influences  creates  ab- 
normal conditions  which  cannot  be  removed  at  will. 
The  chances  are  great  that  many  unintended  bad 
effects  slip  in  and  that  not  a  few  hysterias  may  be 
created  by  a  method  at  the  first  glance  so  startling. 
Much  less  objectionable  is  it  to  make  use  of  the 
effect  of  that  period  of  half-sleep  which  precedes  the 
natural  sleep,  and  which  is  for  many  a  period  of 
increased  suggestibility  for  autosuggestions.  A  reso- 
lution or  the  formulation  of  a  belief  which  would 
be  ineffective  in  a  wide-awake  state  seems  to  get  an 
accentuated  effect  on  the  mind,  if  it  is  repeatedly  ex- 
pressed in  this  transitional  state.  The  psychasthenic 
who  in  such  a  half-dozing  stage  assures  himself  that 
he  will  no  longer  be  afraid  of  going  over  a  bridge  or 


SPECIAL  METHODS  227 

hearing  a  thunderstorm  or  will  feel  a  disgust  for 
whiskey  or  will  have  the  energy  for  work,  has  a 
certain  chance  that  such  autosuggestions  become 
reality  the  next  morning.  With  many  others  there 
seems  no  effect  to  be  obtained  and  not  a  few  seem 
unable  to  catch  the  right  moment.  As  soon  as  they 
begin  to  speak  they  become  wide  awake  or  fall  asleep 
before  they  talk. 

Incomparably  more  value  belongs  to  the  artificial 
sleep,  the  mesmeric  state  of  earlier  days,  the  hyp- 
notism of  our  time.  We  have  discussed  its  theory 
and  recognized  that  an  abnormally  increased  sug- 
gestibility is  indeed  its  chief  feature.  We  know  hyp- 
notism in  most  various  degrees;  the  lowest  can  be 
reached  practically  by  everyone,  the  highest  by  rather 
few.  It  is  almost  arbitrary  to  decide  where  those 
waking  states  with  high  tension  of  suggestibility  end 
and  the  hypnotic  states  begin,  and  not  less  arbitrary 
to  call  the  higher  degrees  only  hypnotism  and  to 
designate  the  lower  degrees  as  hypnoid  states.  If 
we  do  it,  we  certainly  should  acknowledge  from  the 
start  that  the  hypnoid  states  are  for  therapeutic  pur- 
poses not  a  bit  less  important  than  the  full  hypnotic 
states.  Certainly  the  hypnoid  states  do  not  allow 
complex  hallucinations  and  absurd  posthypnotic 
actions,  but  they  offer  excellent  starting  points  for  the 
removal  of  light  obsessions  and  phobias  and  for  the 
reinforcement  of  desirable  impulses,  volitions,  and 
emotions.  Many  persons  cannot  under  any  circum- 
stances be  brought  beyond  such  a  hypnoid  degree. 
The  physician  who  has  not  theoretical  experiments 


228  PSYCHOTHERAPY 

but  practical  success  in  view  ought  therefore  never  to 
trouble  himself  with  the  inquiry  exactly  which  degree 
has  been  reached.  This  advice  is  given  because 
nothing  interferes  with  the  progress  of  hypnotic  in- 
fluence so  badly  as  the  constant  testing.  It  must 
naturally  often  lead  to  a  point  where  the  subject  finds 
that  he  can  very  well  still  do  what  the  hypnotizer  told 
him  not  to  do.  If  the  doctor  assures  him  that  he 
can  no  longer  move  his  arm  and  the  patient  is  yet 
able  to  move  it,  the  doctor  secures  the  very  super- 
fluous knowledge  that  this  special  degree  of  suggesti- 
bility has  not  been  reached,  but  the  patient  is  sliding 
backward  and  the  lower  degree  which  actually  had 
been  reached  will  be  less  accessible  later.  The  phy- 
sician might  rather  resort  to  the  opposite  course  and 
assure  the  patient,  even  after  the  first  treatment  which 
might  have  been  a  slight  success,  that  he  saw  from 
definite  symptoms  that  hypnosis  had  set  in.  That 
will  greatly  smooth  the  way  for  real  hypnotic  effects 
the  next  time. 

The  best  method  of  hypnotizing  is  the  one  which 
relies  essentially  on  the  spoken  word,  awakening 
through  speech  the  idea  of  the  approach  of  sleep. 
If  the  hypnotizer  assures  the  subject  in  monotonous 
words  that  a  feeling  of  fatigue  is  setting  in,  that  he 
is  feeling  a  tiredness  creeping  over  his  shoulders  and 
arms  and  legs,  that  his  memories  are  fading  away 
and  that  he  is  now  hypnotized,  for  not  a  few  all  is 
done  that  is  needed.  The  hypnotic  state  will  come 
and  will  hold  until  the  verbal  suggestion  takes  it 
off  again:  Perhaps  the  hypnotizer  says  that  he  will 


SPECIAL  METHODS  229 

count  three  and  at  three  the  subject  is  to  open  his 
eyes  and  feel  perfectly  comfortable.  It  is  wise  to 
tell  the  patient  beforehand  that  he  will  not  lose  con- 
sciousness and  that  he  will  remember  afterward  what- 
ever happens  as  many  people  believe  that  loss  of 
memory  belongs  to  the  hypnotic  state,  and  that  they 
were  not  hypnotized  if  they  can  remember  what  hap- 
pened. Such  a  skeptical  after-attitude  can  seriously 
interfere  with  the  success  of  the  treatment. 

Yet  in  most  cases,  it  will  be  safer  not  to  rely  on 
words  only  but  to  supplement  them  by  manipulations 
which  all  converge  towards  the  effect  of  increasing 
the  suggestibility  and  thus  of  overcoming  the  resist- 
ance to  the  suggestions  introduced.  It  is  well  known 
that  for  this  purpose  it  is  advisable  to  begin  the  in- 
fluence with  some  slight  fatiguing  stimulations.  The 
effect  is  most  easily  reached  when  the  patient  fixates 
perhaps  a  shining  button  held  over  his  eyes  or  listens 
to  monotonous  sounds.  A  particularly  strong  effect 
belongs  again  to  very  slight  touch  stimuli.  If  the 
subject  with  his  eyes  closed  is  touched  perhaps  by 
two  pencils  at  various  and  unexpected  points  of  the 
face  and  hands,  a  skillful  playing  on  his  tactual  senses 
soon  produces  a  half-dozing  state  of  hypnoid  char- 
acter. In  the  same  group  belong  those  so-called 
passes  which  evidently  have  a  reflex  influence  in  the 
blood-vessel  system.  It  is  advisable  to  combine  the 
various  elements  in  such  a  way  that  at  first  physical 
stimuli  upon  eye  or  skin  produce  an  over-suggestible 
state  and  that  only  as  soon  as  this  state  is  reached  the 
verbal  suggestion  sets  in,  perhaps  with  the  words, 


230  PSYCHOTHERAPY 

"  I  shall  hypnotize  you  now."  Under  such  con- 
ditions every  subject  may  soon  be  brought  to  that 
degree  of  hypnotization  which  is  accessible  to  him. 
Yet  more  than  one  treatment  is  usually  necessary  for 
the  higher  degrees.  Much  less  importance  for  thera- 
peutic purposes  belongs  to  that  hypnoid  state  which  is 
reached  without  the  idea  of  sleep  where  the  subject 
comes  with  open  eyes  into  a  kind  of  fascination,  pro- 
duced perhaps  by  a  sudden  flash  of  light  or  by  the 
firm  eye  of  the  hypnotizer.  It  is  a  state  which  can 
lead  to  a  strong  submission  of  will  and  which  has  its 
legal  importance.  Therapeutically  it  can  hardly  se- 
cure an  effect  which  cannot  better  be  secured  through 
the  real  sleeplike  hypnotism.  Under  certain  condi- 
tions, chemical  substances  may  well  prepare  for  the 
hypnotic  treatment,  for  instance  bromides  or  alco- 
hol. Others  rely  on  the  suggestive  effect  of  flavored 
water.  But  all  that  is  unwise.  The  confidence  of 
the  patient  is  the  best  preparation  for  the  securing  of 
the  helpful  degree  of  hypnotism. 

Of  course  only  a  small  part  of  the  therapeutic  use- 
fulness is  secured  during  the  hypnotic  state  itself. 
A  pain  may  be  removed,  sleep  be  secured,  an  idea  be 
inhibited,  a  movement  be  reehforced  in  cases  where 
non-hypnotic  suggestions  would  have  found  insur- 
mountable obstacles.  During  the  hypnosis  we  may 
also  open  the  storehouse  of  memory  and  bring  to 
light  the  ideas  which  disturbed  the  equilibrium  of  the 
suffering  mind.  Further  in  those  most  complex  hys- 
teric cases  of  dissociated  personality,  new  memory 
connections  may  be  formed  during  the  hypnosis  by 


SPECIAL  METHODS  231 

which  a  synthesis  of  the  double  or  triple  personalities 
into  the  old  one  may  be  secured.  Yet  the  general 
effect  which  the  physician  has  to  hope  for  from 
hypnotic  treatment  is  the  posthypnotic  one.  Not 
what  happens  during  the  hypnosis  but  what  the  sug- 
gestion will  produce  after  hypnosis  is  essential  to  him. 
The  fixed  idea  is  to  disappear  forever,  the  paralyzed 
limb  is  under  control,  the  desire  for  morphine  and 
cocaine  is  gone  for  all  future  time,  the  perverse  long- 
ing is  annihilated,  the  old  energy  is  to  remain  again 
for  all  time.  It  is  the  posthypnotic  after-effective- 
ness which  gives  to  the  hypnoid  and  to  the  hypnotic 
states  their  importance  for  the  treatment  of  the  most 
exasperating  symptoms.  To  be  sure,  the  treatment 
often  must  be  a  prolonged  one.  A  man  who  for 
years  has  used  thirty  grains  of  morphine  a  day  can- 
not be  rid  of  the  desire  after  two  or  three  hypnotic 
sittings.  In  such  a  case  the  treatment  may  cover 
three  or  four  months,  if  it  is  to  be  of  lasting  value  and 
without  any  damage  during  the  treatment. 

Still  we  are  not  at  the  end  of  the  psychotherapeutic 
methods  and  we  may  turn  to  a  fascinating  group  of 
curative  efforts  which  has  especially  come  to  the  fore- 
ground in  recent  years.  We  mentioned  before  that 
mischief  cannot  seldom  be  traced  back  to  earlier  ex- 
periences with  a  strong  unpleasurable  feeling.  In 
certain  cases,  the  subject  remembers  such  particular 
experiences  as  the  beginning  of  his  discomfort;  in 
others,  especially  those  of  hysteric  character,  the 
starting  point  may  have  long  been  forgotten,  and  yet 
that  early  impression  evidently  left  traces  in  the  brain 


232 


PSYCHOTHERAPY; 


which  produce  disturbances  in  conscious  life.  The 
psychotherapist  nowadays  calls  these  groups  of  traces 
"  complexes."  We  recognized  clearly  that  there  is 
no  reason  to  refer  such  forgotten  remainders  of  the 
past  to  any  subconscious  mind;  they  are  physical 
after-effects  which  keep  their  influence  over  the 
equilibrium  of  the  psychophysical  system.  Now 
modern  psychotherapy  finds  that  the  entire  disturb- 
ances which  arise  from  such  emotional  disagreeable 
experiences,  forgotten  or  not  forgotten,  can  often  be 
removed  by  psychical  means.  Two  ways  in  par- 
ticular seem  open.  As  soon  as  the  idea  is  fully 
brought  back  to  consciousness  again,  the  patient  must 
be  made  to  express  the  primary  emotion  with  full  in- 
tensity. Subtle  analysis  has  repeatedly  shown  that 
many  of  the  gravest  hysteric  symptoms  result  from 
such  a  suppression  of  emotions  at  the  beginning  and 
disappear  as  soon  as  the  primary  experience  comes 
to  its  right  motor  discharge  and  gains  its  normal  out- 
let in  action.  The  whole  irritation  becomes  elimi- 
nated, the  emotion  is  relieved  from  suppression  and 
the  source  of  the  cortical  uproar  is  removed  forever. 
Practically  still  more  important  seems  the  other 
case  which  refers  alike  to  hysterics  and  psychasthenics 
and  which  is  applicable  for  the  forgotten  experience 
not  less  than  for  the  well-remembered  ones.  This 
second  way  demands  that  the  psychotherapist  bring 
this  primary  experience  strongly  to  consciousness  and 
then  by  a  new  training  link  it  with  new  and  more 
desirable  associations  and  reactions.  The  disturbing 
idea  is  thus  not  to  be  discharged  but  to  be  side- 


SPECIAL  METHODS  233 

tracked  so  that  in  future  it  leads  to  harmless  results. 
The  new  setting  works  towards  an  entirely  new 
equilibrium.  What  was  a  starting  point  for  ab- 
normal fears  now  becomes  an  indifferent  object  of  in- 
terest and  all  its  evil  consequences  are  cut  off.  It 
may  be  acknowledged  that  the  full  elaboration  of 
these  methods  still  belongs  to  the  future.  Both 
methods,  the  discharging,  or  the  so-called  cathartic 
one,  and  the  side-tracking  method  evidently  demand 
the  discovery  of  the  starting  point  in  the  service  of 
the  therapy  and  here  again  several  methods  are  at 
the  disposa.1  of  the  psychologist. 

A  promising  way  to  this  end  is  the  inexhaustible 
association  test  which  we  mentioned  when  we  dis- 
cussed the  contributions  of  the  psychological  labora- 
tory to  the  medical  diagnosis.  A  series  of  short 
words  are  spoken  to  the  patient  and,  as  soon  as  he 
hears  one,  he  is  to  pronounce  as  quickly  as  possible 
the  first  word  which  comes  to  his  mind.  If  we  use  .  ^ 
fifty  words,  we  should ^be  able  to  learn  something  as 
to  the  inner  states  of  the  man  and  as  to  the  working 
of  his  mind,  if  we  analyze  carefully  his  particular 
choices.  But  two  further  conditions  ought  to  be 
fulfilled.  The  time  of  the  association  ought  to  be 
measured.  Of  course  there  will  be  wide  dif- 
ferences. A  word  which  is  often  in  a  certain  con-  ..  , 
nection  will  quickly  bring  the  habitual  association. 
Abstract  words  will  call  forth  their  associations  more 
slowly  than  concrete  words,  familiar  words  more 
rapidly  than  unfamiliar  words.  To  measure  such 
association  time  with  fullest  accuracy,  as  it  is  necessary 


234  PSYCHOTHERAPY: 

for  the  purpose  of  scientific  investigations,  delicate 
electrical  instruments  are  needed  that  indicate  thou- 
sandths parts  of  a  second.  For  the  purpose  of  the 
practical  physician  such  accuracy  would  be  superfluous!. 
His  examination  will  be  perfectly  successful  if  it  is 
carefully  done  with  a  stop-watch  which  shows  the  fifth 
part  of  a  second,  like  those  which  are  used  at  races. 
He  speaks  a  word,  presses  at  the  same  time  the  button 
of  the  watch,  and  presses  the  stopper  when  he  sees  the 
lips  of  the  patient  moving.  He  is  thus  able  to  examine 
not  only  the  involuntary  choice  of  association  but  also 
the  time  of  every  associative  process.  But  a  second 
^  condition  ought  also  to  be  fulfilled.  After  some  in- 
different words,  others  ought  to  be  mixed  into  the 
series  which  touch  in  a  tentative  way  on  various 
spheres  corresponding  to  the  possible  suspicions. 
The  groups  to  which  the  hidden  thoughts  of  psychas- 
thenics,  for  instance,  belong  are  not  many.  As  soon 
as  our  series  of  words  strikes  such  a  group,  the  re- 
action of  the  mind  may  be  discriminated.  The  effect 
may  be  a  general  perturbation  resulting  either  in 
unusual  delay  of  the  fitting  association  or  in  an  effort 
to  cover  the  sore  spot  by  an  unfitting  association. 
Sometimes  the  dangerous  association  may  rush  for- 
ward even  with  unusual  rapidity  but,  as  soon  as  it  is 
uttered,  it  gives  a  shock  to  the  mental  system,  brings 
the  whole  associative  process  into  disorder,  and  the 
result  is  that  the  next  following  associations  are  ab- 
normally delayed.  The  skilled  psychologist  will 
quickly  take  such  a  change  as  a  cue  for  the  selection 
of  the  later  words  in  his  series.  Of  course,  he  will 


SPECIAL  METHODS  235 

at  first  return  to  neutral  words,  but  as  soon  as  he  has 
found  a  danger  spot,  he  will  approach  it  from  various 
sides,  perhaps  in  every  fourth  or  fifth  word,  and  may 
then  find  out  which  particular  experiences  are  dis- 
quieting the  patient.  Words  like  women  or  money 
or  career  or  family  or  disease  are  often  sufficient  to 
get  the  first  inkling  of  a  mental  story. 

With  less  diagnostic  elegance  we  sometimes  reach 
the  same  end  by  taking  careful  records  of  pulse  and 
breathing  and  involuntary  movements  during  an  ap- 
parently harmless  conversation.  The  instruments  at 
the  disposal  of  the  psychologist  are  those  familiar  to 
every  psychological  laboratory:  the  pneumograph, 
which  registers  the  movements  of  respiration;  the 
sphygmograph,  which  writes  the  pulsation  of  the 
artery  in  the  wrist;  the  automatograph,  or  other 
instruments,  which  register  the  slight  unintentional 
movements  of  the  arm.  If  the  examiner  is 
skillful,  he  will  not  fail  to  discover  the  changes 
in  breathing  and  pulse  and  reaction  as  soon 
as  the  painful  groups  of  ideas  are  approached. 
More  of  theoretic  interest  and  too  cumbersome  for 
practical  diagnosis  is  the  unfailing  galvanic  reaction 
from  the  skin  in  which  the  glands  change  their 
activity  and  their  resistance  to  the  galvanic  current 
under  the  influence  of  hidden  emotions.  Yet  all 
these  methods,  with  exception  of  the  last,  are  es- 
sentially useful  only  if  the  starting  experience  is 
still  accessible  to  the  memory  of  the  patient.  He 
may  be  unaware  that  it  had  anything  to  do  with  his 
nervous  symptoms  but  he  recognizes  the  experience 


236  PSYCHOTHERAPY, 

still  as  soon  as  his  attention  is  directed  towards  it. 
The  psychologically  more  interesting  but  probably 
more  exceptional  situation  is  the  one  in  which  it  is 
not  only  forgotten  but  cannot  be  recognized  when  it 
is  brought  to  consciousness.  The  shortest  way  to  get 
hold  of  such  past  impressions  is  the  hypnotic  one. 
The  hypnotic  state  sharpens  the  memory  and  ex- 
periences of  early  childhood  or  apparently  insignifi- 
cant experiences  of  later  life  may  be  brought  back 
when  they  would  have  been  inaccessible  to  any  in- 
tentional effort  of  the  attention.  Even  still  more 
surprising  is  the  success  if  the  association  is  left  to  a 
dreamy  play  of  ideas  suggested  perhaps  by  gazing 
into  a  crystal  ball  or  by  a  meaningless  talking.  Per- 
haps the  patient  lies  with  closed  eyes  on  the  couch 
while  the  physician  holds  his  hand.  A  few  words 
are  given  to  him  as  a  starting  point  and  then  he  is 
thoughtlessly  to  pronounce  whatever  comes  to  his 
mind,  not  only  unfinished  sentences  but  loose  phrases, 
single  words,  apparently  without  meaning  and  slowly 
ideas  arise  which  betray  the  original  intrusion.  At 
last  memories  and  lost  emotions  come  again  to  the 
surface,  and  the  watchful  psychotherapist  may  dis- 
cover the  complex,  which  'is  then  to  be  removed  by 
discharge  or  by  sidetracking.  This  is  the  so-called 
psychoanalytic  method. 

Finally  the  psychotherapist  may  go  still  one  step 
further.  After  all  it  often  seems  inexplainable  that 
just  this  or  that  emotional  experience  made  such  a 
deep  and  lasting  impression  while  a  thousand  other 
experiences  passed  by  without  leaving  any  mischie- 


SPECIAL  METHODS  237 

vous  after-effect.  It  seems  that  indeed  the  conditions 
are  still  more  complicated.  That  emotional  disturb- 
ance operated  dangerously  perhaps  only  because  it 
itself  appealed  to  a  suppressed  desire  and  this  seems 
to  hold  true  especially  for  suppressed  emotions  of  the 
sexual  sphere.  The  desire  for  gratification  in  nor- 
mal or  abnormal  channels  was  perhaps  attached  by 
the  mind  to  some  group  of  objects.  It  was  com- 
pletely suppressed  but  it  left  an  abnormal  tension  in 
the  central  system.  If  now  a  chance  experience 
touches  on  this  group  of  ideas,  there  results  an 
explosive  reaction;  and  movements,  convulsions, 
spasms,  obsessions,  and  fears  set  in  which  get  their 
particular  character  not  through  the  secondary  in- 
trusion but  from  the  primary  desire.  To  discharge 
that  intrusion  leads  therefore  only  to  the  elimination 
of  those  symptoms  which  resulted  from  it,  but  the 
primary  disturbance  goes  on  and  any  new  chance 
intrusion  will  produce  new  explosions.  The  psycho- 
therapist should  therefore  go  deeper  and  relieve  the 
mind  from  those  primary  desires  which  may  belong 
to  early  youth  and  which  are  entirely  forgotten. 
Even  the  method  of  automatic  writing  may  here 
sometimes  lead  to  an  unveiling  of  those  deepest  layers 
of  suppressed  desires.  In  the  same  way  a  careful, 
subtle  analysis  of  dreams  may  support  the  search  for 
the  hidden  source  of  interference. 

We  have  spoken  of  the  technical  methods  of  the 
psychotherapist.  It  would  be  short-sighted  to  ignore 
the  great  manifoldness  of  secondary  methods  which 
he  shares  with  the  ordinary  intercourse  between  man 


23  8  PSYCHOTHERAPY, 

and  man,  the  methods  which  the  teacher  uses  in  the 
schoolroom,  which  the  parents  use  in  the  nursery, 
which  the  neighbor  uses  with  his  neighbor,  methods 
which  build  up  the  mind,  methods  which  train  the 
mind,  methods  which  reenforce  good  habits  and  sup- 
press unwholesome  ones,  methods  which  stimulate 
sound  emotions  and  inhibit  a  quarrelsome  temper, 
methods  which  indeed  are  not  less  important  in  the 
psychiatric  clinic  and  in  the  hospital  than  in  our  daily 
life,  and  which  certainly  have  central  importance  in 
that  borderland  region  which  is  the  particular  work- 
ing field  of  the  psychotherapist. 


X 

THE  MENTAL  SYMPTOMS 

WE  have  discussed  both  the  psychological 
theory  and  the  practical  work  of  psycho- 
therapy in  a  systematic  order  without  any 
reference  to  personal  chance  experience.  After  study- 
ing the  fundamental  principles,  we  have  sketched  the 
whole  field  of  disturbances  in  which  psychotherapeutic 
influence  might  be  possible  and  all  the  methods  avail- 
able. It  seems  natural  that  our  next  step  should  be 
an  illustrating  of  such  work  by  a  number  of  typical 
cases.  Here  it  seems  advisable  to  leave  the  track  of 
an  objective  system  and  to  turn  to  the  record  of  per- 
sonal observation.  As  this  is  not  a  handbook  for 
the  physician,  dealing  with  the  special  forms  of  dis- 
ease, we  emphasized  before  that  we  avoid  even  any 
attempt  in  such  a  direction  because  it  would  have  to 
introduce  not  only  the  questions  of  diagnosis,  but 
above  all  the  highly  important  questions  of  treat- 
ment by  physical  agencies.  We  saw  that  for  us  noth- 
ing else  can  be  desirable,  but  to  show  the  way  in 
which  the  various  symptoms  which  suggest  mental 
treatment  occur,  and  how  they  yield  to  the  psychical 
methods.  We  had  also  agreed  beforehand  that  for  a 
first  survey  we  might  separate  the  mental  from  the 

339 


240 


PSYCHOTHERAPY 


bodily  symptoms  and  group  the  mental  ones  with 
reference  to  the  predominance  of  ideational,  emo- 
tional, and  volitional  factors.  And  finally  it  may  be 
said  that  we  abstain  from  everything  which  is  excep- 
tional or  even  unusual,  and  confine  ourselves  to  the 
routine  observations  with  which  the  psychotherapist 
comes  in  contact  every  day  and  the  simplest  country 
physician  surely  every  week. 

Thus  I  turn  from  systematic  objectivity  to  my  un- 
systematic reminiscences  of  many  years.  Of  course, 
they  abound  with  eccentric  abnormities  and  startling 
phenomena.  As  I  have  devoted  myself  to  psycho- 
therapeutics,  always  and  only  from  scientific  interest, 
as  a  part  of  my  laboratory  studies  and  therefore  have 
refused  to  spend  any  time  on  cases  which  offered  no 
special  psychological  interest  to  me,  the  striking  and 
sensational  cases  have  prevailed  in  my  practice  even 
to  an  unusual  degree.  Yet  they  are  unessential  for 
our  purposes  here,  the  more  as  their  interest  lies 
mostly  in  the  complex  structure  of  the  mental  state 
while  the  curative  features  are  in  the  background. 
Our  purpose  of  demonstrating  practical  cases  as  they 
occur  in  every  village,  and  as  they  ought  to  be  under- 
stood and  treated  by  every  doctor,  thus  rules  out  just 
those  experiences  which  would  be  prominent  in  a 
theoretical  study  of  abnormal  psychology.  We  want 
to  select  only  simple  commonplace  cases.  Only  those 
who  have  not  learned  to  see  are  unaware  that  such 
cases  are  everywhere  about  them. 

As  a  matter  of  course,  I  also  leave  out  everything 
which  refers  to  insanity,  that  is,  every  mental  dis- 


THE  MENTAL  SYMPTOMS         241 

turbance  which  lies  essentially  outside  of  the  domain 
of  psychotherapy.  The  helpful  influence  which 
psychical  factors  can  exert  in  the  asylums  for  the  in- 
sane is,  as  we  emphasized,  entirely  secondary.  The 
psychotherapeutic  methods  in  the  narrower  sense  of 
the  word  are  in  the  present  state  of  our  knowledge 
ineffective  in  the  insane  asylum.  I  should  also  be 
unable  to  speak  of  laboratory  experience  with  insan- 
ity, as  I  insist  on  sanitarium  treatment  in  every  such 
case.  The  question  of  how  to  differentiate  the  diag- 
nosis of  insanity  from  that  of  the  other  mental  ab- 
normities is  not  our  question  at  this  moment.  I  select 
the  few  illustrations  which  seem  to  me  desirable  for 
the  purpose  of  making  more  concrete  our  abstract 
discussion  of  methods,  essentially  from  the  class  of 
neurasthenics,  psychasthenics,  hysterics,  and  so  on. 

In  all  these  reports,  I  shall  confine  the  account  to 
the  few  points  which  are  to  illustrate  the  psychical 
factors,  thus  abstaining  entirely  from  the  further  de- 
tails which  any  medical  history  of  the  cases  would 
demand  and  from  all  results  of  further  examination 
and  other  particulars.  As  a  matter  of  course,  I  ex- 
clude the  possibility  of  identifying  the  patient.  I 
may  start  with  a  typical  case  of  obsessing  ideas  of 
simplest  character  and  with  simple  routine  treatment 
illustrating  the  emphasis  on  antagonistic  ideas. 

A  man  of  mature  age,  well  educated,  well  built  and  in 
every  respect  in  good  health,  without  nervous  history  and 
without  other  nervous  symptoms,  suffered  vehemently  by 
the  persistent  recurrence  of  a  visual  image  which  entirely 


242  PSYCHOTHERAPY! 

absorbed  his  attention.  He  knew  exactly  the  development 
of  his  trouble.  A  woman  acquaintance  of  his  had  committed 
suicide  by  poisoning  herself.  He  knew  her  slightly  and 
the  emotion  of  personal  loss  played  hardly  any  role  in  the 
case.  But  he  had  met  her  at  a  gay  dinner  a  short  time 
before  her  death.  The  news  of  the  suicide  came  to  him 
when  he  was  overtired  from  work.  The  idea  of  the  con- 
trast between  seeing  his  friend  partaking  of  the  dinner  and 
imagining  her  drinking  the  poison  gave  him  a  strong  shock. 
There  was  hardly  any  grief  mixed  in.  He  remembers  that 
he  shivered  at  the  thought  of  the  contrast,  and  in  that  mo- 
ment the  visual  image  of  the  woman  raising  a  glass  of 
poison  to  her  mouth  flashed  into  his  mind  and  thus  be- 
came almost  a  part  of  the  shock.  From  that  time  on,  the 
memory  image  of  this  scene  returned  more  and  more  fre- 
quently. At  first  it  associated  itself  with  any  chance  men- 
tioning of  death  or  suicide  and  to  a  very  slight  degree  with 
the  idea  of  a  meal.  More  and  more  any  element  of  a 
meal  and  of  social  life,  the  word  soup  or  meat,  the  word 
gown  or  dance,  brought  up  at  once  the  picture  of  the 
woman,  which  had  in  the  meantime  lost  every  element  of 
personal  relation.  Any  sad  thought  of  her  ending  had 
faded  away.  It  remained  merely  a  troublesome  impression. 
The  man  fought  against  it  by  trying  to  suppress  the  idea 
but  the  more  he  fought  against  it,  the  more  insistently  it 
rushed  forward  through  new  and  ever  new  association  paths. 
Any  advertisement  in  the  newspaper  referring  to  food,  any- 
thing in  a  shop  window  referring  to  ladies'  dresses,  any 
household  utensils  related  to  a  meal,  and  especially  the  meals 
themselves,  forced  the  visual  image  into  the  centre  and  cap- 
tured the  attention  to  such  a  degree  that  a  confusing  dis- 
traction from  the  real  surroundings  resulted.  The  struggle 
against  the  idea  became  more  and  more  exasperating,  made 


THE  MENTAL  SYMPTOMS         243 

life  a  torture,  almost  suggested  despair,  even  faint  thoughts 
of  suicide,  and  especially  a  growing  fear  that  it  was  a  symp- 
tom of  the  beginning  of  insanity. 

When  he  came  to  me,  a  number  of  physical  cures,  es- 
pecially bromides  and  electricity,  had  been  tried  in  vain  by 
the  physician.  Some  weeks  in  the  country  had  not  changed 
the  distress.  He  came  to  me  with  the  direct  request  as  a 
last  resort  to  try  hypnotic  treatment.  I  found  in  spite 
of  the  fact  that  he  and  his  physician  had  constantly  spoken 
of  visual  hallucinations  that  the  visual  image  had  no  hal- 
lucinatory character  at  all,  that  is,  he  never  believed  that 
he  saw  the  image  of  that  woman  as  if  it  were  actually  pres- 
ent, he  never  took  the  product  of  his  imagination  for  reality, 
nor  had  it  the  vividness  and  character  of  reality.  It  was 
hardly  more  vivid  than  any  landscape  which  he  tried  to 
remember,  only  that  it  controlled  the  interplay  of  ideas  in 
such  a  persistent  way.  I  found  that  he  was  a  strong  visual- 
izer  and  easily  suggestible.  I  told  him  beforehand  that  I 
should  hypnotize  him  only  to  a  slight  degree,  that  he  would 
not  lose  consciousness,  that  he  would  remember  everything 
which  I  told  him.  Then  I  asked  him  to  lie  down  and  had 
him  gaze  on  a  crystal  only  for  half  a  minute,  then  close 
the  eyes.  I  asked  him  to  relax  and  to  think  of  sleep.  With 
the  two  blunt  points  of  a  compass,  I  touched  his  two  cheeks 
at  corresponding  places,  then  his  forehead.  And  now  I 
told  him  that  I  would  begin  with  the  hypnotic  influence.  I 
put  my  hand  on  his  forehead  and  spoke  to  him  in  a  monot- 
onous way,  saying  that  he  felt  a  fatigue  in  his  shoulders, 
and  in  his  arms,  creeping  over  his  whole  body  and  assured 
him  that  he  was  now  fully  hypnotized.  To  what  degree 
he  really  was  hypnotized  cannot  be  said  as  no  effort  was 
made  to  test  it  by  any  experiments,  thus  avoiding  any  pos- 
sible reaction  against  the  feeling  of  submission.  Expression 


244  PSYCHOTHERAPY 

and  breathing  indicated  a  slight  hypnoid  state.  Then  I 
removed  my  hand  and  spoke  to  him  in  a  warm  and  assuring 
way. 

I  told  him  that  in  future  he  would  give  his  full  atten- 
tion to  his  meal,  and  not  give  the  slightest  attention  to  any 
image  of  his  friend.  If  he  should  think  of  the  friend  the 
memory  would  appear  indifferent,  he  would  not  even  notice 
the  image  and  would  give  his  whole  mind  to  the  objects 
with  which  he  was  engaged.  In  the  same  way,  when  he 
should  be  reading  newspapers  or  looking  in  shopwindows, 
his  whole  attention  would  belong  to  that  which  he  really 
perceived.  Any  passing  inner  image  would  be  ignored. 
Then  I  awoke  him  from  his  sleep.  He  was  unwilling  to 
believe  that  he  had  been  in  hypnosis  at  all.  I  told  him  that 
the  effect  would  prove  it  and  in  his  fully  wakeful  state 
I  explained  to  him  why  there  was  not  the  slightest  fear  of 
insanity  justified,  that  it  was  a  psychasthenic  state  resulting 
from  fatigue  and  shock  and  from  a  wrong  attitude  of  his 
attention  during  the  past  months,  and  then  I  asked  him  to 
return  the  next  day.  Intentionally  I  had  not  given  the 
suggestion  that  the  image  would  disappear.  I  could  not 
expect  it  would  disappear  entirely  after  a  first  treatment 
and  even  a  faint  appearance  of  it  would  have  at  once  fas- 
cinated the  attention  and  brought  about  the  whole  dis- 
turbance of  the  equilibrium  which  might  become  habitual. 
Instead  of  it  I  gave  the  impulse  to  the  counteridea,  that 
is,  I  reenforced  the  attention  towards  that  which  he  really 
saw  around  him  and  thus  withdrew  the  attention  from  the 
rival  image  in  the  mind.  The  success  was  complete.  He 
came  the  next  day  in  a  much  happier  frame  of  mind,  re- 
porting that  he  still  had  seen  the  image  of  the  woman  every 
few  minutes,  especially  strongly  at  the  breakfast  table,  but 
it  had  no  longer  troubled  him.  It  was  more  in  the  back- 


THE  MENTAL  SYMPTOMS         245- 

ground  of  consciousness,  sometimes  it  appeared  transparent, 
it  no  longer  held  his  attention,  and  he  felt  free  to  give  his 
full  attention  to  the  actual  surroundings. 

On  that  basis  I  hypnotized  him  the  second  day  and  he 
had  hardly  heard  me  saying  that  he  ought  to  try  to  sleep 
when  he  was  evidently  in  a  much  deeper  hypnotic  state  than 
the  first  time.  Again  I  suggested  only  the  opposite  attitude, 
the  positive  turning  to  the  surroundings  and  the  complete 
neglect  and  indifference  for  the  possible  memory  image. 
This  time  the  effect  was  still  stronger.  On  the  third  day 
he  reported  that  he  still  saw  the  image  but  he  no  longer 
minded  it,  as  it  was  like  a  veil  through  which  he  looked 
at  real  objects  and  that  left  him  entirely  indifferent.  His 
mind  was  hardly  engaged  with  it  any  more.  The  real  spell 
of  the  attention  was  broken.  On  the  basis  of  this  situation, 
I  took  the  last  step  and  suggested  that  the  image  of  the 
woman  would  disappear  altogether  and  would  not  trouble 
him  any  more.  In  the  next  twenty-four  hours,  it  still  re- 
turned two  or  three  times,  but  colorless  and  faint.  The 
following  day  I  was  able  to  eliminate  it  altogether.  Even 
when  the  last  trace  of  the  inner  struggle  between  the 
memory  and  the  perceived  surroundings  had  disappeared,  I 
went  on  with  two  hypnotic  sittings  to  give  stability  to  the 
new  equilibrium,  to  insist  that  the  image  would  not  come 
back  and  to  settle  completely  that  inner  repose  with  which 
every  fear  of  possible  disease  evaporated.  I  feel  sure  that 
the  cure  would  not  have  been  reached  so  quickly,  possibly 
not  at  all,  if  the  second  suggestion,  the  disappearance  of  the 
image,  had  been  given  at  the  first  step.  The  improvement 
was  secured  because  the  antagonistic  process  Itself  was  used 
for  the  suggestion,.  On  the  other  hand,  there  was  no  doubt 
that  in  this  case  the  strong  will  of  the  patient  or  suggestion 
in  a  normal  state  would  not  alone  have  been  sufficient.  The 


246  PSYCHOTHERAPY 

hypnotic  treatment  was  indicated  by  the  symptoms  and  jus- 
tified by  the  results. 

I  may  take  another  typical  case  in  which  also  the 
obsession  was  brought  about  by  an  idea  without  emo- 
tional value  or  at  least  by  an  idea  which  had  lost  its 
emotional  character;  the  idea  came  somewhat  nearer 
to  hallucination,  but  had  its  chief  elements  on  tactual 
ground  where  the  transition  from  image  to  hallucina- 
tory perception  is  easier.  I  add  this  case  to  demon- 
strate that  hypnosis  is  not  the  only  open  way  of 
treatment  in  such  cases  and  that  the  variations  must 
always  be  adjusted  to  the  special  conditions.  The 
case  gains  importance  by  the  fact  that  the  patient 
was  himself  a  physician  well  trained  in  mental  ob- 
servation. 

The  patient  Is  a  highly  educated  physician  of  middle  age. 
He  reports  that  he  had  been  neurasthenic  all  his  life  with 
slight  ever-changing  symptoms.  He  has  always  been  troubled 
by  the  "  perseveration  "  of  tactual  images  which  had  a  strong 
feeling  tone  and  which  were  associated  with  seen  or  heard 
reports  of  the  experiences  of  others.  For  instance,  when  he 
read  in  a  newspaper  that  someone  had  hurt  his  hand  with 
a  pin,  or  that  someone  had  cut  his  foot  on  a  nail, 
he  immediately  felt  a  not  directly  painful  but  uncom- 
fortable sensation  at  the  particular  place  in  the  hand  or  in 
the  foot,  together  with  a  shrinking  of  the  whole  body  and 
such  tactual  sensation  usually  returned  during  the  following 
days  in  fainter  and  fainter  form  until  it  faded  away.  Most 
troublesome  had  always  been  the  reading  of  any  torture  proc- 
esses in  historical  books  or  in  fiction.  Yet  there  had  never 
been  a  case  in  which  the  sensations  really  had  the  vividness 


THE  MENTAL  SYMPTOMS         247 

of  hallucinations  and  never  a  case  in  which  the  after  effects 
had  not  disappeared  at  least  in  a  few  weeks. 

This  time  the  effect  had  already  lasted  four  months  and 
it  became  more  and  more  troublesome.  The  patient  had 
not  the  slightest  fear  of  mental  disease  and  no  anxiety,  but 
he  felt  a  very  serious  disturbance  by  the  instinctive  effort 
to  get  rid  of  the  intrusion.  The  place  of  the  disturbance 
was  the  wrists.  The  starting  point  was  a  definite  experi- 
ence. On  an  unusually  hot  summer  day  the  physician  had 
listened  for  a  long  time  to  the  complaints  of  a  female  pa- 
tient who  suffered  vehemently  from  a  nervous  fear  of  scis- 
sors and  knives  and  who  was  afraid  that  she  would  cut 
her  artery  at  the  wrist.  He  believes  that  it  was  the  ex- 
hausting heat  of  the  day  which  weakened  him  to  a  point 
where  the  story  of  his  patient  affected  him  very  strongly 
and  made  him  think  of  it  all  the  time.  Yet  there  was  no  sen- 
sation element  involved.  A  few  hours  later,  he  sat  in  a 
hotel  at  his  dinner.  Just  in  front  of  him  a  butler  started 
to  carve  a  duck  with  a  long,  sharp  knife.  In  that  moment 
he  felt  as  if  the  knife  passed  through  the  wrists  of  both 
arms.  He  felt  for  a  moment  almost  faint;  arms  and  legs 
were  contracted  and  an  almost  painful  sensation  lingered  in 
the  skin,  and  did  not  disappear  for  hours. 

From  that  day  at  the  sight  of  knives  or  razors,  not  only 
in  his  hands  or  his  direct  neighborhood,  but  also  in  a  store 
and  finally  in  a  picture,  stired  up  at  once  the  optical  image 
of  that  carving  knife  cutting  into  the  skin  of  the  wrist, 
only  with  the  difference  that  it  seldom  was  found  in  both 
arms,  usually  in  the  one  or  the  other.  The  sensation  be- 
came a  strictly  tactual  one  with  optical  overtone,  but  there 
was  no  emotion  in  it.  The  pain  element  had  disappeared. 
Also  the  shock,  which  still  recurred  in  the  first  days  slowly 
disappeared.  The  longer  the  symptom  lasted,  the  more  the 


1248  PSYCHOTHERAPY 

optical  factor  faded  away,  and  the  tactual  factor  came  into 
the  foreground  after  three  or  four  weeks.  Perhaps  seeing  a 
razor  in  a  store  window  or  a  pocket  knife  open  no  longer 
stirred  up  the  image  of  cutting  the  wrist,  but  simply  a  strong 
tactual  sensation,  as  if  the  skin  of  the  wrist  was  scratched  and 
pinched.  Finally,  after  about  two  months,  the  association 
character  disappeared  to  a  high  degree  and  the  scratching  and 
cutting  sensation  in  the  skin  became  independent  and  auto- 
matic. The  patient  awoke  in  the  morning  with  a  vivid  tac- 
tual hallucination  of  being  cut  without  associating  with  it  any 
picture  of  a  knife.  Throughout  the  day,  in  the  midst  of  work 
and  in  the  midst  of  conversation,  sometimes  one  and  some- 
times the  other  wrist  became  the  center  of  the  exasperat- 
ing sensation,  easily  bringing  with  it  involuntary  reactions 
as  if  to  withdraw  the  arm.  This  became  more  and  more 
frequent  and  more  and  more  vivid. 

The  doctor,  fully  aware  of  the  borderland  character  of 
this  experience,  felt  sure  that  his  inner  fight  against  the  dis- 
turbance would  get  control  of  it.  The  usual  tonics  did  not 
show  any  influence.  On  the  other  hand,  there  were  no  other 
nervous  symptoms  and,  with  his  most  acute  analysis,  he  did 
not  find  the  slightest  trace  of  emotion  any  longer.  When 
the  symptoms  reached  a  point  at  which  they  seriously  in- 
terfered with  his  comfort,  he  asked  me  for  psychotherapeutic 
treatment,  under  the  condition  that  I  was  not  to  apply  hyp- 
notism. He  was  absolutely  averse  to  the  use  of  hypnotism 
in  his  own  case  because  he  was  afraid  that  to  be  hypnotized 
would  mean  for  him  a  certain  disposition  to  fall  into  hyp- 
notic sleep  by  auto-suggestion,  as  he  knew  the  vividness  of 
his  imaginative  sensations.  He  wanted  to  avoid  that  the 
more  as  his  own  professional  work  might  sometimes  de- 
mand hypnotizing  in  his  own  practice.  In  any  case  he  had 
an  aversion  to  it  and  asked  for  other  means. 


THE  MENTAL  SYMPTOMS         249 

Under  these  circumstances,  it  seemed  to  me  the  most 
logical  conclusion  that  the  counter  idea  with  its  antagonistic 
reactions  might  be  reenforced  by  direct  perception.  The 
abnormal  tactual  sensation  forced  on  consciousness  the  idea 
of  the  cutting  of  the  wrist.  The  necessary  counter  action 
would  be  to  force  'to  consciousness  the  idea  of  the  uninjured 
wrist  and  the  corresponding  reactions.  As  the  wrist  can  be 
easily  made  accessible  to  sight  and  as  I  anticipated  that  the 
visual  sensations  would  be  more  forceful  than  the  tactual 
ones,  I  told  him  to  look  straight  at  his  own  wrists  for  ten 
minutes  three  times  a  day  after  waking,  after  luncheon,  and 
before  going  to  bed.  He  had  to  hold  his  two  forearms  close 
in  front  of  his  eyes  and  stare  at  them,  giving  his  full  atten- 
tion to  the  visual  impression  of  the  smooth,  uninjured  skin 
of  the  wrist.  If  during  this  process,  the  tactual  counter- 
sensations  were  vivid,  he  had  to  go  on  with  the  staring  at 
both  arms,  both  held  near  together  until  the  perception  had 
crowded  out  the  rival  touch  sensation.  When  this  per- 
formance had  been  carried  out  six  times,  he  did  not  notice 
the  coming  up  of  the  tactual  sensation  with  vividness  any 
longer.  From  the  third  day  it  had  disappeared  entirely.  I 
told  him  to  go  on  with  the  process  still  every  morning  for 
some  weeks.  The  physician  himself  considered  the  cure  as 
complete. 

Our  first  case  dealt  with  hypnosis,  our  second  case 
removed  the  intruding  idea  by  a  perception  in  a  wak- 
ing state.  To  point  at  once  to  the  variety  of  methods 
which  we  sketched,  we  may  turn  again  to  a  case  of 
emotionless  idea  removed  by  the  method  of  switching 
off  and  side-tracking  the  originating  and  physiological 
"  complex." 


250  PSYCHOTHERAPY 

The  patient  is  a  school-teacher  in  the  Middle  West,  a  nerv- 
ous, thin-looking  woman  of  about  twenty-five.  Her  only 
complaint  is  a  persistent  idea  that  she  may  at  any  time  get 
a  child.  She  has  had  this  idea  "  as  long  as  she  can  remem- 
ber," according  to  her  first  expression.  She  never  had  any 
intimate  acquaintance  with  any  man,  she  was  never  engaged, 
she  hated  bitterly  every  thought  of  immorality,  she  knows 
and  has  assured  herself  by  much  reading  that  it  is  entirely 
impossible  that  she  might  get  a  child  without  sexual  con- 
tact. Yet  this  thought  recurs  to  her  all  the  time,  even  when 
she  is  talking  with  other  people.  It  embarrasses  her  in 
school,  in  spite  of  her  teaching  only  girls  in  a  private  insti- 
tution. This  thought  keeps  her  away  from  company  and 
the  effect  of  its  embarrassing  occurrence  depresses  her,  but 
she  is  sure  that  the  thought  itself  does  not  include  any  emo- 
tion. It  is  a  mere  thinking  of  it  with  a  full  consciousness 
that  it  is  absurd,  and  yet  she  cannot  suppress  it. 

I  began  at  once  to  try  to  find  the  origin  of  her  queer 
obsession.  After  some  efforts  to  pierce  into  her  memories, 
we  came  to  an  experience  of  her  youth.  When  she  was  about 
thirteen  years  of  age,  a  young  girl  whom  she  had  admired 
much  for  her  beauty,  living  in  the  neighborhood  of  her 
parents,  suddenly  got  a  child  which  died  after  a  few  days. 
At  that  time  no  thought  of  immorality  seems  to  have  en- 
tered into  that  news.  It  was  evidently  mere  sadness  about 
the  quick  death  of  the  child  which  gave  to  the  experience 
its  emotional  tone.  She  was  at  that  time  completely  naive. 
She  received  an  intense  shock  in  the  thought  that  an  un- 
married girl  may  suddenly  get  a  child  which  would  then 
quickly  die.  She  cannot  tell  whether  the  thought  that  she 
herself  would  get  a  child  had  ever  entered  her  mind  before 
this  occurrence  in  her  neighborhood,  nor  can  she  say  that  it 
occurred  immediately  or  very  soon  after  it.  She  now  knows 


THE  MENTAL  SYMPTOMS         251 

only  that  she  has  always  had  that  thought,  but  whether  that 
means  more  than  ten  years,  she  does  not  know. 

I  considered  it  a  justifiable  hypothesis  that  this  strong 
emotional  experience  early  in  life  had  become  the  starting 
point  for  that  secondary  absurd  thought.  I  considered  that 
primary  experience  as  cause  for  a  deep  physiological  brain 
excitement  which  had  irradiated  towards  the  ideas  of  her 
personality.  It  had  stirred  up  there  associations  which  kept 
their  psychological  character  while  the  primary  disturbance 
had  long  lost  its  psychical  accompaniment.  It  worked  its 
mischief  in  a  physiological  sphere  but  was  probably  still  the 
starting  point  for  the  persistent  obsession.  My  aim  was  to 
remove  this  cause.  It  would  have  brought  little  improve- 
ment simply  to  suppress  the  freak  idea  as  long  as  that  phys- 
iological source  was  active.  On  the  other  hand  I  should 
not  have  the  means  to  stop  the  physiological  after-effects  of 
that  real  experience:  I  had  to  sidetrack  it  and  to  secure  thus 
a  reduction.  I  decided  therefore  to  work  on  the  basis  of  that 
hypothesis,  to  accept  that  physiological  complex  as  existing, 
but  to  switch  it  off  by  linking  it  with  appropriate  associations, 
thus  setting  it  right  in  the  whole  system  of  her  thoughts. 

For  that  purpose  I  brought  her  into  a  hypnoid  state,  bend- 
ing her  head  backwards  and  speaking  to  her  with  slow  voice 
until  I  saw  that  a  slight  drowsy  state  was  reached.  In  this 
state  I  asked  her  to  think  back  as  vividly  as  she  could  of 
that  experience  of  her  youth,  to  fancy  herself  meeting  that 
pretty  girl,  her  neighbor,  once  more.  She  is  to  imagine  that 
she  speaks  with  her.  Now  I  make  her  talk  with  me  and 
she  assures  me  that  she  sees  the  scene  distinctly.  She  be- 
lieves she  sees  the  girl  on  the  street.  I  ask  her  to  tell  the 
girl  how  indignant  she  feels  over  her  behavior;  she  is  to  tell 
her  that  she  understands  now  all  which  she  did  not  under- 
stand in  her  childhood,  that  she  knows  now  that  she  must 


252  PSYCHOTHERAPY 

have  lived  an  immoral  life ;  that  she  must  have  had  a  friend 
and  that  a  pure  girl  like  herself  could  never  under  any 
circumstances  come  into  such  a  situation,  that  no  pure  girl 
could  suddenly  have  a  child.  She  is  to  express  to  the  other 
girl  her  deepest  disapproval  of  such  conduct  and  her  own 
feeling  of  happiness  that  anything  like  that  could  never  hap- 
pen to  her.  In  accordance  with  my  demands,  she  worked 
herself  entirely  into  the  scene:  without  using  audible  voice, 
she  internally  spoke  with  great  vividness  to  her  neigh- 
bor. When  I  awoke  her  from  her  drowsy  state,  she  was 
quite  exhausted  from  the  excitement.  I  repeated  that  scene 
with  her  four  times.  She  assured  me  that  she  felt  it  every 
time  more  dramatically.  The  power  of  the  obsession  weak- 
ened from  the  first  day.  After  the  fourth  time,  it  had  disap- 
peared. The  subcortical  complex  had  evidently  found  its 
normal  channels  of  discharge. 

In  discussing  this  method  of  side-tracking  the  com- 
plex, we  mentioned  that  in  other  cases  the  result  is 
reached  by  bringing  the  memory  of  that  first  experi- 
ence to  a  vivid  motor  discharge,  without  substituting 
any  other  ideas.  For  that  purpose  no  direct  personal 
influence  is  necessary.  Treatment  might  just  as  well 
be  performed  "  by  correspondence,"  provided  that  the 
right  starting  point  is  discovered  and  that  right  sug- 
gestions are  given.  As  an  illustration,  I  may  choose  a 
case  which  shows  at  least  the  maximum  distance  treat- 
ment by  mail,  from  Boston  to  Seattle.  This  particu- 
lar case  presented  no  difficulty  in  getting  hold  of  the 
starting  point  as  my  correspondent,  whom  I  have 
never  seen,  himself  at  once  pointed  to  the  original 
source  of  his  obsessing  idea. 


THE  MENTAL  SYMPTOMS         253 

The  patient  who  lived  with  his  family  in  Seattle  wrote 

to  me  the  following:  " I  shall  undertake  to  describe 

in  a  few  words  a  condition  which  the  writer  has  fought 
against  for  about  eight  years  and  which  has  subjected  him 

to  untold  mental  anguish.     I  was  backward  in  a 

social  way  but  altogether  happy.  After  working  in  a  bank 
about  a  year,  was  discovered  one  evening  by  the  cashier 
smoking  a  cigar  in  the  basement,  was  unable  to  look  him 
in  the  face  at  the  time.  Went  home  that  night  and  thought 
very  little  about  it,  but  on  the  following  morning  during 
the  regular  course  of  business,  I  stepped  up  to  him  to  ask 
some  question,  and  as  usual,  unconsciously  looked  him  in 
the  face.  His  glance  was  questioning  and  suspicious,  and 
that  was  the  beginning  of  a  life  of  anguish  for  me.  At  first 
I  could  not  look  him  in  the  eyes,  then  when  looking  at  some 
other  person,  I  happened  to  think  of  it  and  so  on,  until  in 
two  or  three  days  it  was  impossible  to  look  at  anyone  who 
came  to  my  window.  The  cashier  did  everything  he  could 
for  me.  No  use :  I  quit  my  position,  lost  most  of  my  friends, 
had  to  leave  a  happy  home  and  came  to  Seattle  to  work  for 
an  old  school  friend.  In  the  first  year,  owing  to  new  en- 
vironments, I  managed  to  conceal  my  mental  condition  to  a 
certain  degree.  All  of  a  sudden,  I  was  again  plunged  into 
the  depths  of  black  despair.  It  took  me  about  two  years 
to  (partially)  forget  it,  when  the  same  thing  occurred  again, 
and  I  lost  my  grip.  The  last  time  about  eighteen  months 
ago  was  almost  more  than  I  could  stand.  These  three  or 
four  instances  I  speak  of  were  cases  of  extreme  despondency, 
but  my  usual  mental  condition  is  extremely  unhappy.  If 
occasions  arise  where  I  have  to  sit  and  talk  to  anyone  for 
ten  minutes,  controlling  myself  is  such  an  effort  that  it 
leaves  me  with  a  case  of  the  blues.  ...  I  shall  come  and 
see  you  as  the  relief  would  give  me  a  new  lease  on  life." 


254  PSYCHOTHERAPY 

This  letter  was  written  on  the  twenty-third  of  January, 
1908.  I  replied  to  him  at  once  that  he  certainly  ought  not 
to  come  from  the  Pacific  to  the  Atlantic,  but  that  I  wanted 
him  to  write  to  me  much  more  about  that  first  occurrence. 
As  he  was  evidently  right  in  considering  that  episode  as  the 
starting  point  of  his  troublesome  associations,  I  supposed  that 
these  associated  ideas  had  not  yet  become  independent  but 
were  still  the  effect  of  that  first  "  complex."  Therefore  I 
wanted  to  bring  that  to  complete  discharge.  Accordingly  I 
wrote  him  to  think  himself  once  more  into  that  happening 
of  years  ago,  to  pass  through  it  with  all  the  power  of  his 
imagination,  to  describe  it  to  me  then  in  as  full  a  statement 
as  possible  and  to  express  in  the  letter  also  his  conviction 
that  there  was  no  reason  to  avoid  the  eyes  of  his  superior, 
that  he  might  have  looked  straight  into  his  face.  As  soon 
as  he  got  my  reply,  he  wrote  to  me  on  the  sixth  of  Febru- 
ary a  description  of  that  first  episode,  filling  nineteen  pages, 
telling  me  all  about  his  relations  to  those  various  men  and 
every  minute  detail  was  brought  clearly  to  consciousness 
again.  I  did  not  add  anything  further,  but  the  expected 
occurred.  On  the  eighteenth  of  February,  he  writes  to  me: 
"  In  the  last  week  or  ten  days,  the  writer  has  noted  a  de- 
cided improvement  regarding  mental  condition.  The  result 
is  a  new  interest  in  life.  If  you  can  spare  the  time,  would 
like  to  have  you  write  me  a  few  lines.  Gratefully  yours." 
At  the  end  of  the  month  he  writes:  "  Received  your  letter 
about  half  an  hour  ago.  Hasten  to  assure  you  with  a  great 
deal  of  pleasure  that  I  am  feeling  much  better.  Since  send- 
ing you  the  letter  regarding  the  first  case,  I  have  noticed 
day  by  day  an  improvement."  On  the  eighth  of  March: 
"  Since  writing  you  last  I  have  noticed  a  gradual  improve- 
ment. It  has  given  me  wonderful  encouragement."  On 
the  tenth  of  March :  "  Just  a  line  to  say  that  I  am  still 


THE  MENTAL  SYMPTOMS         255 

improving."  On  the  twelfth  of  April :  "  I  desire  to  say  that 
since  the  taking  up  of  treatment  with  you,  life  has  had  a  far 
different  appearance  to  me  than  it  has  had  for  the  last  ten 
years."  On  the  twenty-first  of  April :  "  Since  my  first  letter 
to  you,  there  has  been  such  an  improvement  that  I  have  ac- 
cepted a  position  which  carries  with  it  much  responsibility." 

This  case  leads  over  to  the  large  group  in  which 
the  obsessing  idea  involves  the  relation  to  a  particular 
person.  I  find  in  such  cases  autosuggestion  more 
liberating  than  heterosuggestion  if  the  development 
has  not  gone  too  far.  Of  course  autosuggestion  can 
never  take  hypnotic  character,  but  makes  use  with 
profit  of  the  transition  state  before  normal  sleep. 
The  type  of  these  cases  which  are  everywhere  about 
us  may  be  indicated  by  the  following  letter. 

The  writer  is  a  young  woman  of  twenty-four,  whom  I  did 
not  know  personally.  She  wrote  to  me  as  follows:  "  I  am 
a  writer  by  profession  and  during  the  last  year  and  a  half 
have  been  connected  with  a  leading  magazine.  In  my  work, 
I  was  constantly  associated  with  one  man,  the  managing 
editor.  This  man  exerted  a  very  peculiar  influence  over 
me.  With  everyone  else  connected  with  the  magazine,  I 
was  my  natural  self  and  at  ease,  but  the  minute  this  man 
came  into  the  room,  I  became  an  entirely  different  person, 
timid,  nervous,  and  awkward,  always  placing  myself  and  my 
work  in  a  bad  light.  But  under  this  man's  influence,  I  did 
a  great  deal  of  literary  work,  my  own  and  his  too.  I  felt 
that  he  willed  me  to  do  it.  The  effect  of  this  influence  was 
that  I  suffered  constantly  from  deep  fits  of  depression  almost 
amounting  to  melancholia.  This  lasted  until  last  fall,  when 
I  felt  that  I  should  lose  my  mind  if  I  stayed  under  his 
influence  any  longer.  So  I  resigned  my  position  and  broke 


256  PSYCHOTHERAPY 

away.  Then  I  felt  like  a  person  who,  having  a  drug  to 
stimulate  him  to  do  a  certain  amount  of  work,  has  that 
drug  suddenly  taken  away,  and  without  it  I  am  unable  to 
write  at  all.  ..."  I  wrote  to  the  young  lady  that  she  could 
cure  herself  without  hypnotism  and  without  my  personal 
participation.  I  urged  her  simply  to  speak  to  herself  early 
in  the  morning  and  especially  in  the  evening  before  going 
to  sleep,  and  to  say  to  herself  that  the  man  had  never  helped 
her  at  her  work,  but  that  she  did  it  entirely  of  her  own 
power,  and  that  he  had  never  had  any  influence  on  it,  and 
that  she  can  write  splendidly  since  she  has  left  the  place,  and 
much  better  than  before.  A  few  months  later,  she  came  to 
Cambridge  and  thanked  me  for  the  complete  success  which 
the  auto-suggestive  treatment  had  secured.  She  was  com- 
pletely herself  again  and  was  fully  successful  in  filling  a 
literary  position  in  which  she  had  to  write  the  editorials, 
the  book  reviews,  the  dramatic  criticisms,  and  the  social 
news.  As  a  matter  of  course,  such  treatment  had  removed 
only  the  symptom.  The  oversuggestible  constitution  had  not 
been  and  could  not  be  changed.  Thus  it  was  not  surprising 
that  in  the  meantime,  while  her  full  literary  strength  had 
come  back,  she  had  developed  some  entirely  different  symp- 
toms of  bodily  character  which  I  had  to  remove  by  hyp- 
notism. 

As  soon  as  the  obsessing  idea  of  the  influence  of 
another  person  takes  still  a  stronger  hold  and  develops 
systems,  the  suspicion  of  insanity  always  lies  near; 
especially  when  hallucinations  are  superadded,  the 
probability  is  great  that  we  then  have  to  do  with  the 
delusions  of  a  paranoiac,  and  thus  no  case  for  psycho- 
therapeutic  treatment.  Yet  it  is  always  wise  to  keep 
a  psychasthenic  interpretation  in  view  as  long  as  the 


THE  MENTAL  SYMPTOMS         257 

insanity  is  not  evident.     I  may  mention  such  an  ex- 
treme case. 

The  patient,  a  man  of  middle  age,  highly  educated,  for 
years  had  heard  voices  calling  his  name.  A  man  with  whom 
he  had  some  personal  quarrel,  had,  as  he  believed,  hypnotized 
him  from  a  distance  and  made  him  act  queerly  or  do  things 
which  he  really  did  not  want  to  do,  by  telepathic  influence. 
It  is  a  development  which  is  found  quite  frequently.  Ab- 
normal organic  sensations  or  abnormal  impulses  and  inhibi- 
tions which  the  patient  cannot  account  for  by  his  own  mo- 
tives become  connected  with  some  vague  ideas  which  are  in 
the  air,  like  wireless  telegraphy  or  telepathy  or  hypnotism 
from  a  distance  or  electrical  influence,  or  magnetism  or 
telephoning,  these  then  attached  to  an  acquaintance  who 
stands  in  a  certain  emotional  relation.  Here,  too,  some  or- 
ganic sensations  evidently  had  been  the  starting  point  and 
the  idea  of  the  man  with  whom  he  quarreled  had  been  sec- 
ondarily attached.  From  this  starting  point  more  and  more 
detail  was  reached.  Every  action  was  brought  into  connec- 
tion with  the  powerful  enemy  who  controlled  more  and 
more  even  the  normal  and  reasonable  doings  of  the  patient. 
My  first  impression  was  decidedly  that  of  a  paranoiac.  Yet 
in  some  ways  the  case  suggested  another  view.  There  had 
remained  an  insight  into  the  unreality  of  the  obsession.  The 
patient  did  not  really  believe  the  theory  of  the  telepathic 
hypnotic  influence.  He  felt  it  more  as  an  idea  which  he 
could  not  get  rid  of  and  he  did  not  know  clearly  himself 
whether  he  requested  hypnotic  treatment  on  my  part  for  the 
purpose  of  counteracting  the  hypnotic  power  of  his  enemy  or 
for  the  purpose  of  liberating  him  from  his  exasperating  fixed 
idea.  Moreover,  I  found  that  his  voices  had  no  hallucina- 
tory character,  but  were  merely  sound  images.  I  decided  to 
make  the  experiment  without  great  hope  of  success. 


258  PSYCHOTHERAPY) 

I  hypnotized  the  man  deeply  and  suggested  that  no  one 
can  have  power  over  his  actions,  that  he  is  the  responsible 
originator  of  everything  that  he  does  and  that  no  one  can 
influence  him  and  that  from  that  hour  he  would  feel  free 
from  any  telepathic  intrigue.  The  effect  of  the  very  in- 
sistent and  urgently  repeated  hypnotic  suggestion  during  the 
first  rather  long  treatment  was  such  a  surprisingly  good  one 
that  I  decided  to  continue  the  psychotherapeutic  cure.  I 
hypnotized  him  daily  for  two  weeks.  The  belief  in  the 
real  wrong  doings  of  an  enemy  disappeared  entirely  from 
the  first.  It  was  at  once  apprehended  as  a  mere  obsessing 
idea  in  the  own  mind  and  this  idea  itself  began  to  be  re- 
solved. It  lost  its  unity;  the  absurd  impulses  were  still  felt 
but  they  became  less  and  less  connected  with  the  idea  of 
another  man,  and  as  soon  as  they  were  rightly  understood 
as  doings  of  the  own  mind,  the  opposite  motives  gained  in 
strength.  A  stronger  and  stronger  appeal  to  his  own  power 
made  these  motives  more  and  more  influential.  Slowly  the 
association  of  the  influence  of  the  other  man  faded  away 
entirely.  I  intentionally  had  not  given  any  attention  to  the 
pseudo-voices,  inasmuch  as  they  had  not  taken  any  relation 
to  the  ideational  delusion.  I  therefore  did  not  include  them 
in  my  suggestions,  as  I  consider  it  wise  to  confine  hypnotic 
suggestions  always  to  as  few  points  as  possible.  Yet  these 
voices  decreased  too.  At  a  certain  point  in  the  cure  I  sub- 
stituted— to  save  my  own  time — an  autosuggestive  influence, 
or  rather  a  mixed  one,  inasmuch  as  I  had  him  read  ten  times 
a  day  a  letter  of  mine  which  contained  appropriate  sugges- 
tions. After  about  six  weeks,  all  the  disturbances  for  which 
he  had  sought  my  advice  had  disappeared. 

Obsessing  ideas  of  such  personal  influence  involve 
of  course  always  a  certain  amount  of  emotional  ex- 


THE  MENTAL  SYMPTOMS         259 

citement  and  they  may  lead  us  to  the  unlimited  field 
of  disturbances  in  which  the  persecuting  idea  is  sur- 
rounded by  emotional  attitudes.  Analysis  shows 
easily  that  the  emotion  is  an  essential  factor  and 
that  it  persists  in  the  disease  while  the  ideas  to  which 
it  clings  may  change.  Central  is  the  emotion  of  fear; 
nearest  to  it  that  of  worry,  but  any  emotion  may  give 
color  to  the  particular  case.  Again  any  number  of 
methods  may  be  applied  and  a  few  illustrations 
with  quite  different  ways  of  treatment  may  indicate 
more  fully  the  character  of  the  trouble.  There  is  no 
doctor  in  the  city  and  none  in  the  remotest  village 
who  may  not  find  such  cases  in  his  near  neighbor- 
hood. Of  course  slight  degrees  are  easily  hidden  by 
the  patient's  own  inhibition  of  external  expression. 
If  such  suppression  by  the  own  will  secures  a  real 
overcoming  of  the  unjustified  emotion,  this  is  surely 
better  than  to  begin  any  medical  treatment.  But  as 
the  suppression  usually  means  simply  lack  of  dis- 
charge and  thus  offers  all  the  conditions  for  an  un- 
healthy inner  growth  of  the  trouble,  the  neglect  of 
such  disturbances  is  most  regrettable,  and  frankness 
of  the  patient  must  be  encouraged.  Such  situation 
demands  a  careful  observation  of  the  whole  case  and 
a  subtle  adjustment  of  the  treatment  to  the  individual 
needs.  It  may  perhaps  be  helpful  at  first  simply  to 
indicate  the  varieties  of  the  more  frequent  disturb- 
ances of  this  kind  by  quoting  from  various  letters. 
Each  case  belongs  to  a  type  which  can  easily  be  re- 
moved by  psychotherapeutic  influence,  generally  even 
by  a  skillfully  directed  autosuggestion. 


26o  PSYCHOTHERAPY 

The  writer  is  a  young  man. 

"  I  have  always,  as  long  as  I  can  remember,  been  very 
nervous  and  sensitive.  When  about  seven  years  of  age,  I 
was  attacked  by  St.  Vitus'  Dance.  Before  that  I  cannot 
say  whether  I  was  particularly  nervous  or  not.  Afterward 
it  was  impressed  upon  me  by  the  remarks  of  relatives  that 
I  was  nervous,  so  that  I  soon  took  note  of  this  condition 
myself.  The  manner  in  which  this  weakness  has  been  es- 
pecially troublesome  is  that  it  has  caused  me  to  be  very  shy. 
I  shrank  from  new  acquaintances  and  disliked  being  observed. 
Often  in  walking  along  on  the  street,  I  imagined  myself  closely 
noticed  by  the  passerby  and  I  always  felt  uncomfortable. 

About  three  years  ago  I  suffered  from  typhoid  fever  and 
after  recovering,  a  new  form  of  the  old  trouble  showed  it- 
self. This  time  I  imagined  that  when  eating  I  chewed  my 
food  in  a  manner  that  was  ridiculous  and  which  made  people 
hardly  keep  from  laughter  in  observing  me.  Often  I  had 
to  leave  the  table  when  half  through  because  I  felt  I  could 
not  bear  having  critical  eyes  upon  me  any  longer.  About 
three  months  ago  I  determined  to  be  troubled  no  further  by 
my  own  foolish  fancies  and  by  constantly  schooling  myself 
I  have  improved  very  much.  Still,  however,  when  I  walk 
alone  along  the  street,  I  must  fortify  myself  mentally  be- 
fore passing  each  group  of  people.  If  once  I  allow  myself 
to  think  that  they  are  looking  at  me,  I  feel  almost  paralyzed, 
my  feet  seem  too  heavy  to  lift,  my  arms  do  not  seem  to 
swing  naturally,  and  in  attempting  to  look  placid  and  un- 
concerned, I  feel  that  I  am  failing  utterly.  Also  when  at 
table,  I  must  still  tell  myself  before  each  mouthful  that 
I  have  no  need  for  fear,  that  my  manner  at  table  is  equal 
and  perhaps  superior  to  the  others  beside  me.  I  have  gone 
a  certain  length  in  my  self-training,  and  have  relieved  my- 
self of  a  great  deal  of  the  mental  distress,  but  now  I  believe 


THE  MENTAL  SYMPTOMS         261 

I  can  advance  no  further.  What  seems  needful  now  is  to 
do  away  with  the  self -consciousness  which  brought  on  my 
worries,  though  whether  this  is  possible  is  hard  to  say." 

Here  the  letter  of  a  young  woman,  the  type  which 
fills  the  army  of  the  mind  healers  and  faith  curists. 

"  For  years  I  have  been  seeking,  or  perhaps  to  be  more 
accurate  I  should  say  waiting,  for  a  mind  to  drift  toward 
me;  a  mind  that  would  understand  my  particular  case  of 
fear  brought  on  by  the  constant  bullying  and  nagging  from 
my  earliest  childhood  by  those  in  my  home.  This  fear  of 
brutality  has  greatly  depleted  my  nervous  system  and  has 
unfitted  me  for  the  strong,  useful,  forceful  life  I  should 
have  expressed.  If  I  could  only  rid  my  mind  of  the  thought 
that  I  am  always  displeasing,  or  rather  going  to  displease 
people,  for  I  hardly  do  displease  them ;  if  I  could  get  rid  of 
the  fear  of  caring  what  the  attitude  of  other  minds  toward 
me  is,  I  feel  that  I  should  then  strike  out  into  a  strong  life 
of  helpfulness  to  others.  In  other  words  I  have  always  felt 
behind  me  a  great  force  pressing  me  out  into  public  work. 
When  I  was  a  child,  it  was  so  strong  that  I  was  sat  down 
upon  brutally,  to  so  great  an  extent  that  I  feared  to  voice 
my  convictions  and  that  fear  still  clings  to  me  like  a  neme- 
sis. It  seems  that  every  individual  personality  in  a  public 
or  private  audience  rises  up  to  overwhelm  me,  causing  my 
tongue  to  grow  heavy  and  my  mind  to  become  a  blank. 
This  enervating  fear  blends  into  every  thought  I  have, 
whether  sleeping  or  waking.  I  have  fought  with  all  my 
might  to  rid  myself  of  it  but  so  far  in  vain." 

Here  an  expression  of  a  very  frequent  variety. 
The  writer  is  a  middle-aged  man. 


262  PSYCHOTHERAPY 

"  I  am  possessed  of  a  fear  that  is  constantly  with  me  that 
something  dreadful  is  going  to  happen  and  I  do  not  seem 
to  be  able  to  overcome  it.  I  am  told  by  physicians  that  I 
am  bodily  sound,  although  very  nervous,  and  that  the  fear 
is  generated  entirely  by  autosuggestion.  When  at  its  worst, 
it  weakens  and  terrorizes  me  and  in  my  better  moments  I 
am  tormented  with  a  fear  of  a  recurrence  of  a  bad  spell. 
It  is  fear  of  a  fear.  A  year  ago  at  this  time  I  had  a  very 
bad  spell  but  got  along  fairly  well  through  the  summer, 
but  I  am  afraid  that  I  will  soon  again  be  in  a  bad  condi- 
tion and  lose  all  that  I  may  have  gained." 

The  "  fear  of  a  fear  "  is  indeed  a  symptom  which 
the  psychotherapist  has  to  fight  extremely  often,  but 
as  soon  as  he  has  really  recognized  it  and  analyzed 
the  whole  mental  condition,  he  will  hardly  have  any 
difficulty  in  uprooting  it.  I  add  a  letter  of  a  school- 
teacher in  New  York.  He  writes : 

"  I  am  teaching  in  a  high  school.  I  am  of  a  nervous 
temperament  and  constitutionally  limited  in  endurance. 
Often  my  work  is  done  in  a  condition  of  greater  or  less 
exhaustion.  I  find  that  I  blush  very  easily  in  purely  freak- 
ish ways,  when  there  is  no  occasion  for  it.  I  find  this  blush- 
ing connecting  itself  with  certain  of  the  girl  pupils  of  my 
classes  in  a  conspicuous  way.  It  occurs  hardly  ever  except 
when  my  class  is  facing  me  and  I  seem  to  be  powerless  to 
overcome  it.  I  have  always  tried  to  live  a  careful  moral 
life,  but  my  early  life  was  very  much  secluded.  I  lacked 
entirely  the  free  intercourse  young  people  usually  have  to- 
gether and  I  felt  awkward  with  others  for  a  long  time.  In 
the  matter  of  the  blushing,  it  sometimes  occurs  in  the  case 
of  girls  who  are  especially  pleasing  to  me  but  also  not  in- 


THE  MENTAL  SYMPTOMS         263 

frequently  in  the  case  of  some  who  are  not  at  all  so.  The 
whole  thing  might  be  passed  over  were  it  not  that  it  has 
considerable  effect  in  causing  constraint  toward  my  stu- 
dents and  in  some  cases  affecting  them  very  strongly  in  an 
emotional  way  at  the  very  time  of  life  when  such  things 
can  do  most  harm.  I  regard  the  matter  as  being  so  serious 
that  it  brings  directly  in  question  my  right  to  teach,  but  I 
do  not  feel  at  all  sure  I  could  find  other  work  that  I  could 
do  if  I  give  up  my  present  position.  The  very  thought  that 
on  a  particular  occasion  it  would  be  extremely  awkward  to 
blush  makes  it  almost  impossible  for  me  to  avoid  it." 

But  we  have  rather  now  to  consider  the  therapeu- 
tic side,  and  we  may  begin  again  with  a  routine 
method  of  a  simple  hypnotic  treatment. 

The  patient  is  a  young  university  professor.  His  intel- 
lectual work  is  perfect  in  all  directions.  There  are  no 
nervous  symptoms,  though  there  are  some  slight  dis- 
turbances of  digestion.  He  suffers  as  soon  as  he  comes  into 
a  crowd  of  people  and  as  soon  as  he  is  on  any  high  place, 
where  he  has  to  look  down ;  the  worst  when  both  conditions 
are  combined,  as  for  instance,  at  a  concert  or  a  theatre  in 
a  balcony  seat.  But  every  meeting  of  many  persons,  even 
at  church,  produces  all  the  symptoms  of  nervous  excite- 
ment. He  was  easily  brought  into  hypnotic  state  by  verbal 
suggestions.  When  he  was  in  hypnosis,  I  reenforced  the 
conditions  for  an  opposite  attitude.  I  told  him  that  as  soon 
as  he  was  in  a  crowd  of  persons  he  would  feel  especially 
comfortable,  would  enjoy  himself,  would  fully  enter  into 
the  spirit  of  the  occasion  and  feel  especially  secure  in  their 
presence.  Whenever  he  should  be  on  a  high  place,  he  would 
enjoy  the  safety  of  the  ground  on  which  he  was  standing  or 


164  PSYCHOTHERAPY 

the  seat  on  which  he  was  sitting.  I  assured  him  that  he 
would  neglect  entirely  whatever  he  saw  and  would  rely 
completely  on  his  safe  feeling  resulting  from  his  tactual 
impressions.  After  having  hypnotized  him  three  times  the 
disturbance  disappeared  completely,  and  even  an  evening  at 
the  theatre  in  an  exposed  box  on  the  balcony  was  enjoyed 
without  any  discomfort.  After  about  a  year,  at  a  period  of 
fatiguing  work,  some  traces  of  the  anxiety  appeared  again. 
This  time  two  hypnotic  sittings  were  sufficient  to  remove 
the  disturbance  of  the  equilibrium,  which  as  far  as  I  know 
has  not  come  back.  The  same  hypnotic  treatments  were 
used  in  a  secondary  way  to  remove  the  digestive  trouble. 

I  again  quote  the  case  of  a  teacher,  a  profession  in 
which  the  psychasthenics  are  unusually  frequent.  It 
is  a  case  of  a  young  woman  from  the  Middle  West. 

The  young  lady  wrote  me :  "  I  come  of  a  race  of  strong 
women  and  am  not  hysterical  or  easily  frightened  by  many 
things  that  disturb  women.  Since  my  fifteenth  year  I  have 
been  seized  by  hallucinations  of  absurd  or  serious  nature 
which  no  reasoning  could  explain  away  and  which  have 
gradually  undermined  my  power  of  resistance  to  them.  At 
the  age  of  twenty-two,  after  a  year  of  unusually  hard  work, 
my  nervous  endurance  gave  way,  and  with  this  breakdown 
came  a  sense  of  fear  and  a  horror  of  crime  that  I  have  been 
unable  to  overcome.  I  have  never  felt  the  slightest  in- 
clination toward  wrongdoing.  It  is  a  feeling  rather  that 
my  shrinking  from  any  mention  of  evil  makes  it  impossible 
for  me  to  listen  or  think  rationally  when  such  things  are 
discussed.  This  feeling  has  seemed  to  change  my  whole 
attitude  toward  life  and  has  left  me  without  power  to  con- 
trol my  facial  expression  or  carriage  when  it  takes  possession 
of  me.  I  have  been  able  to  teach  more  successfully  than  I 


THE  MENTAL  SYMPTOMS         265 

could  hope,  but  it  is  only  by  cutting  myself  off  from  the 
friendships  and  pleasures  incident  to  my  life  that  I  am  able 
to  accomplish  my  work.  I  have  fought  this  trouble  alone 
and  will  still  do  so  if  there  is  no  help,  but  the  thought  that 
it  is  the  source  of  great  distress  to  those  dear  to  me  makes 
it  very  hard." 

A  few  weeks  later  the  lady  insisted  on  coming  to  Cam- 
bridge. I  found  that  there  had  never  been  any  hallucina- 
tions and  that  she  used  the  word  in  her  letter  only  to  indi- 
cate some  insistent  memory  images  which  had  never  taken 
the  vividness  of  real  impressions.  In  the  presence  of  her 
friend,  I  hypnotized  her  deeply  and  strengthened  through 
urgent  suggestions  her  consciousness  of  her  having  done  the 
morally  right  thing  at  every  situation  in  her  life  and  her 
conviction  that  she  never  did  and  never  would  commit  a 
crime.  Here  as  always,  if  possible,  I  left  alone  the  emo- 
tional idea  but  reenforced  the  opposite.  The  effect  was  an 
immediate  one.  She  felt  freer  the  next  day  than  she  had 
felt  for  years.  I  repeated  the  treatment  a  few  times  and 
she  assured  me  that  the  feeling  had  disappeared  entirely. 

I  take  the  rather  severe  case  of  a  woman  of  fifty. 

The  highly  educated  and  refined  lady  had  lost  her  hus- 
band by  an  accident  in  Switzerland,  which  had  been  mis- 
represented by  some  of  the  newspapers  as  suicide.  Two 
years  later  she  wrote  to  me :  "I  feel  as  if  I  had  received 
indelible  photographs  on  my  brain  which  have  since  greatly 
affected  my  health  and  from  which  I  may  never  recover. 
This  winter  the  symptoms  I  have  been  able  to  control  re- 
turned and  I  have  been  ill.  I  unfortunately  saw  the  news- 
paper headlines  with  my  husband's  supposed  suicide.  Though 
I  exclaimed  then,  '  how  outrageous,'  I  felt  as  if  I  had  been 
struck  and  since  then  I  can  seldom  read  a  paper  without 


266  PSYCHOTHERAPY 

dread  and  apprehension,  and  the  hearing  of  anyone's  suicide 
fills  me  with  terror.  When  I  hurried  to  Europe,  on  the 
ocean  a  week  from  the  day  of  my  husband's  death,  I  had 
a  curious  and  overwhelming  shock.  On  opening  a  drawer 
and  seeing  a  pair  of  scissors,  they  looked  to  me  like  a  dagger 
and  suddenly  the  whole  cabin  seemed  filled  with  implements 
of  death.  The  doctors  said  that  I  would  find  it  hard  to 
get  over  such  impressions  but  I  told  them  I  would,  as  I 
had  courage  and  will.  But  I  have  been  realizing  in  these 
two  years  that  I  may  be  suffering  from  something  that  may 
be  beyond  the  control  of  will.  I  often  become  so  nervously 
sensitive  that  scissors  are  unbearable  for  me  to  see,  or  a 
steel  knife  or  anything  that  might  express  death.  Our 
family  physicians  are  still  against  hypnotism,  and  if  I  should 
go  to  a  neurologist  of  my  own  selection,  it  might  be  to 
one  who  believed  still  only  in  nerve  foods,  baths,  or  a  sani- 
tarium." 

The  lady  came  from  the  South,  with  her  nurse,  to  Bos- 
ton and  insisted  on  being  hypnotized  by  me.  I  cannot  say 
whether  a  really  deep  hypnotic  state  was  produced  at  once 
as  I  refrained  from  testing  it.  There  was  certainly  no  am- 
nesia. Probably  it  began  only  with  a  slight  drowsiness  but 
at  the  fifth  treatment  I  found  a  relatively  deep  hypnosis.  It 
was  a  capricious  case  in  which  the  improvement  was  fluctu- 
ating but  clearly  setting  in  from  the  first  day.  I  trained 
her  in  hearing  and  seeing  words  like  death  and  suicide  with 
a  reenforced  feeling  of  strength  and  calmness;  I  forced  her 
to  see  and  touch  scissors  with  an  artificial  attitude  of  strength 
and  indifference.  At  the  same  time  I  reenforced  her  good 
mood  and  her  enjoyment  in  life.  When  she  left  for  Eng- 
land a  few  weeks  later,  she  felt  herself  mentally  cured,  and 
throughout  the  summer  her  letters  testified  the  wonderful 
change  which  the  treatment  had  brought  about.  Half  a 


THE  MENTAL  SYMPTOMS         267 

year  later,  as  the  result  of  an  exhausting  physical  local  treat- 
ment, the  psychophysiological  symptoms  came  back  to  a  cer- 
tain degree.  She  requested  me  by  a  letter  from  England 
to  give  her  some  help  by  suggestion  to  suppress  again  the 
recurring  intrusions.  As  I  had  observed  her  strong  sug- 
gestibility, I  sent  her  over  the  ocean  a  little  pencil  of  mother- 
of-pearl  which  she  had  seen  in  my  hand,  and  advised  her 
to  look  at  it  until  she  counted  twenty  slowly  and  then  to 
close  her  eyes  and  simply  to  sleep.  The  autosuggestive  effect 
was  unusually  strong.  She  writes  from  London :  "  When  I 
saw  the  enclosure  of  your  letter  I  felt  as  if  it  would  burn 
through  my  hand  and  the  feeling  became  so  overpowering 
that  I  locked  it  away  with  my  jewels,  but  as  the  days  ran 
into  a  week  I  felt  I  could  not  live  with  it  in  my  apartment 
any  more,  and  I  felt  almost  ill,  until  it  occurred  to  me 
I  could  seal  it  and  take  it  to  my  bankers.  I  felt  as  dreamy 
and  absent-minded  and  paralyzed  as  if  you  had  just  treated 
me."  Nevertheless  the  effect  was  on  the  whole  the  desired 
one  and  she  returned  to  America  with  a  wholesome  freedom 
of  mind.  I  hypnotized  her  twice  again  and  she  writes  in 
her  last  letter:  "  I  can  never  repay  you  for  what  you  have 
done  for  me.  You  have  given  me  back  my  courage  and 
my  love  of  life  in  its  vividness  and  interest  and  color,  all 
that  through  the  last  years  I  had  so  entirely  lost." 

Even  in  cases  where  the  disease  itself  is  inaccessible 
to  psychotherapeutic  treatment,  the  superadded  grief 
and  worry  brought  on  by  the  disease  might  yield  to 
the  mental  influence  and  the  whole  situation  would 
to  a  high  degree  be  transformed  for  the  better  by  it. 
I  have  often  been  asked  to  hypnotize  In  such  cases, 
where  the  depression  was  wrongly  taken  as  a  part  of 


268  PSYCHOTHERAPY, 

the  nervous  disease;  sometimes  I  agreed  to  do  it  in 
spite  of  feeling  sure  that  the  disease  itself  could  not  be 
removed.  I  quote  an  instance. 

A  young  woman  afflicted  with  epilepsy  was  brought  up  in 
the  belief  that  she  had  only  from  time  to  time  fainting 
attacks  from  overwork,  and  with  them  secondarily  neuras- 
thenic symptoms,  especially  spells  of  depression  colored  by  a 
constant  fear  of  the  next  fainting.  She  had  heard  voices 
all  her  life  and  they  frightened  her  in  an  intolerable  way. 
I  produced  a  very  slight  hypnotic  state.  I  concentrated  my 
effort  entirely  on  suggestions  which  were  to  give  her  new 
interest  in  life,  and  diminished  the  emotional  character  of 
the  voices  without  even  trying  to  make  them  disappear.  I 
proceeded  for  several  months.  The  young  woman  herself 
believed  that  the  fainting  attacks  came  less  frequently  after- 
wards; yet  I  am  inclined  to  think  that  that  is  an  illusion. 
But  there  was  no  doubt  that  her  whole  personality  became 
almost  a  different  one  with  the  new  share  in  the  world.  The 
epilepsy  remained  probably  unchanged  but  all  the  super- 
added  emotions  were  annihilated  and  she  felt  an  entirely 
new  courage  which  allowed  her  to  control  herself  between 
her  regular  attacks.  She  had  been  unable  to  undertake  any 
regular  work  before  for  a  long  while,  but  all  that  improved. 
More  than  a  year  afterward,  she  wrote  me:  "I  have  really 
worked  most  of  the  time  this  past  winter  and  spring  and  I 
think  I  can  see  a  steady  though  slow  gain.  I  am  reading 
quite  a  little  and  doing  it  for  the  most  part  easily.  To  be 
sure  I  have,  after  I  have  read,  hard  times  with  the  voices 
but  their  character  is  usually  less  determined  and  fearful 
than  formerly.  Several  times  I  have  thought  I  must  come 
again  to  you  but  each  time  I  have  started  again  to  fight  it 
out  for  myself,  but  now,  as  I  am  gaining,  I  can  better  esti- 


THE  MENTAL  SYMPTOMS         269 

mate  the  great  help  your  influence  was  to  me  at  a  juncture 
when  everything  seemed  so  hopeless  and  helpless." 

Even  in  slight  psychasthenic  disturbances,  the 
psychotherapeutic  influence  is  not  always  successful, 
especially  if  there  is  no  time  for  full  treatment.  But 
it  is  very  interesting  to  see  how  even  in  such  cases  the 
symptom  is  somehow  changing,  almost  breaking  to 
pieces.  It  becomes  clear  that  a  protracted  effort  in 
the  same  direction  would  destroy  the  trouble  com- 
pletely. Typical  is  a  case  like  the  following. 

An  elderly  woman  has  been  troubled  her  life  long  by  a 
disproportionate  fear  of  thunderstorms  with  almost  hyster- 
ical symptoms.  As  she  had  no  other  complaint,  I  hardly 
found  it  worth  while  to  enter  into  a  systematic  treatment 
and  could  not  expect  much  of  a  change  from  a  short  treat- 
ment, considering  that  her  hysteric  response  had  lasted 
through  half  a  century.  As  she  begged  for  some  treatment, 
I  brought  her  into  a  drowsy  state  and  told  her  that  she 
would  in  future  enjoy  the  thunderstorms  as  noble  expres- 
sions of  nature.  The  whole  procedure  took  a  few  minutes. 
Yet  after  some  summer  months  she  wrote  me  a  letter  which 
clearly  indicated  this  characteristic  compromise  between  the 
habitual  dread  and  the  reenforced  counter  idea.  "  I  have 
the  same  sick  dread  at  the  sight  of  thunder  clouds  that  I 
.  have  always  had,  but  I  seem  to  have  gotten  somehow  a  most 
desperate  determination  to  control  my  fear.  I  have  done 
this  to  the  extent  of  keeping  my  eyes  open  and  looking  at 
the  storm.  Is  that  hypnotism  or  pride  ?  " 

Another  thunderstorm  case  may  lead  us  to  other 
methods  of  treatment.  Here  again  in  the  field  of 


270  PSYCHOTHERAPY 

emotional  response,  we  may  consider  the  methods 
of  going  back  to  primary  experience,  known  or  for- 
gotten. 

A  young  married  woman  of  the  West  had  suffered  al- 
ways from  hysterical  attacks  in  response  to  any  sharp  sud- 
den impressions,  especially  sudden  loud  noises.  The  bang- 
ing of  a  door,  but  worst  of  all  a  thunderstorm,  could  pro- 
duce hours  of  weeping  and  crying  and  desperate  mental  con- 
dition with  all  expressions  of  excitement.  Her  husband 
wanted  me  to  hypnotize  her  but  I  preferred  another  way. 
I  tried  to  get  her  memory  back  to  the  earliest  case  of  which 
she  could  think  of  this  hysterical  response.  As  long  as  we 
were  in  ordinary  conversation,  she  could  not  trace  it  beyond 
about  her  twelfth  year.  But  when  I  brought  her  into  a 
drowsy  state,  her  memory  revived  older  experiences  and 
finally  settled  at  a  school  experience  in  her  seventh  year 
of  age.  She  then  had  an  excitable  country  school-teacher 
who  relied  on  whipping  the  children.  Once  her  neighbor 
in  the  class  did  something  forbidden.  Her  teacher  mistook 
her  for  the  culprit  and  began  to  whip  her  most  forcibly 
before  she  could  explain  anything;  and  while  the  punish- 
ment was  going  on  and  she  began  to  bleed  from  a  wound, 
she  all  the  time  felt  that  she  wanted  to  express  her  inno- 
cence and  could  not  speak.  After  that,  evidently  the  first 
attack  of  hysteric  character  followed.  From  that  time  on 
any  sudden  impression  released  the  same  group  of  reactions. 
The  suppressed  emotion  had  evidently  become  a  psycho- 
physical  "  complex."  As  soon  as  I  had  reached  this  starting 
point  of  her  pathological  history,  I  asked  her  to  bring  back 
to  consciousness  as  many  details  as  possible  of  that  first  in- 
cident. She  told  me  all  the  names  and  described  the  class- 
room and  brought  herself  vividly  into  the  whole  situation. 


THE  MENTAL  SYMPTOMS         271 

Then  I  asked  her  to  tell  me  the  whole  story  once  more  and 
to  express  strongly  her  innocence  and  the  wrongness  of  the 
punishment,  and  when  she  had  completed  her  account, 
brought  out  with  fullest  indignation,  I  had  her  tell  the  whole 
thing  once  more  and  then  a  third  and  a  fourth  time,  until 
she  was  quite  tired  out  from  it.  That  was  all  I  did.  Very 
soon  after,  the  husband  reported  that  there  was  a  great  im- 
provement in  every  respect,  no  hysteric  attacks,  only  slight 
discomfort.  Most  of  the  stimuli  which  had  previously  pro- 
duced strong  reactions  now  passed  without  any  disturbance 
and  even  thunderstorms  were  experienced  with  relative 
ease.  A  year  later  they  came  once  more  to  Cambridge,  and 
she  simply  passed  once  more  through  the  same  process  of 
discharge  which  seems  now  to  have  removed  the  symptoms 
still  further. 

By  far  more  reliable,  however,  is  the  method  of 
side-tracking  the  starting  experience  into  a  new  asso- 
ciational  track. 

A  gentleman  with  a  decidedly  psychasthenic  constitution 
developed  a  tendency  to  hesitate  in  walking  on  the  street. 
It  was  not  a  complete  stumbling  but  a  disturbing  inhibition, 
which  set  in  when  he  was  walking  alone  and  his  attention 
was  not  absorbed  by  something  on  the  street.  He  believed 
that  it  came  on  most  strongly  when  he  looked  down  at  the 
pavement.  He  suffered  from  it  vehemently  and  avoided 
going  on  the  street  alone.  He  was  unable  to  connect  it 
with  any  starting  point.  He  interpreted  it  as  merely  a 
symptom  of  overwork.  But  going  with  him  through  all 
kinds  of  experiences  which  he  had  had  on  the  street  in 
previous  years,  we  finally  found  that  once  he  was  running 
to  catch  a  street  car,  when  he  suddenly  saw  almost  immedi- 


272  PSYCHOTHERAPY 

ately  before  him  a  big  hole  dug  out  for  laying  gas  pipes. 
He  was  able  to  stop  himself  quickly  enough  not  to  fall  into 
the  hole  but  he  got  a  strong  emotional  shock  from  the  ex- 
perience. He,  himself,  did  not  think  that  his  walking 
troubles  set  in  immediately  after  this  shock.  Yet  the  hypo- 
thesis seemed  to  me  sufficiently  justified  that  there  existed 
a  connection,  even  though  some  weeks  lay  between  that  first 
experience  and  the  first  observation  of  the  abnormal  inhibi- 
tion in  walking.  On  that  basis  I  tried  to  train  a  new  as- 
sociative connection.  I  made  him  drowsy  and  asked  him 
to  think  himself  once  more  into  the  situation  of  his  run 
for  the  car  but  as  soon  as  he  reached  the  hole  to  jump 
over  it.  He  went  through  this  motor  feature  on  ten  suc- 
cessive days  with  new  and  ever  new  energy  and  from  that 
time  up  to  the  present  the  trouble  on  the  street  has  disap- 
peared entirely. 

To  mention  at  least  one  case  of  the  large  group 
in  which  suppressed  sexual  emotion  was  the  evident 
source  of  an  anxiety-neurosis,  I  mention  the  case  of 
a  woman  who  showed  very  strong  symptoms  of 
anxiety  and  oppression  and  who  was  cured  by  a  sim- 
ple advice. 

The  woman,  aged  thirty-two,  was  a  saleswoman  in  a 
large  store  selling  gentlemen's  gloves  and  ties.  She  suf- 
fered from  time  to  time  by  attacks  of  vague  anxiety  in 
which  her  heart  showed  vehement  palpitation.  There  were 
paleness  and  perspiration  and  at  the  height  a  nervous 
trembling  together  with  a  feeling  of  despair.  These  attacks 
were  not  frequent,  separated  sometimes  by  weeks,  sometimes 
by  months,  but  troubling  her  exceedingly.  She  had  been 
assured  by  a  physician  that  her  heart  was  normal  and  that 


THE  MENTAL  SYMPTOMS         273 

she  was  probably  overworked.  She  could  find  absolutely  no 
source  of  the  disturbance.  After  a  long  conversation,  I  was 
also  unable  to  discover  any  direct  or  indirect  causes  until 
I  worked  on  the  basis  of  those  theories  which  we  have  dis- 
cussed, the  theories  which  connect  hysteric  symptoms  with 
chance  intrusions  which  stand  in  relations  to  past  suppressed 
emotions  of  sexual  character.  The  patient  absolutely  denied 
any  present  sexual  emotions.  She  had  been  engaged  about 
eight  years  before  and  acknowledged  that  at  that  time  there 
were  strong  sexual  feelings  connected  with  her  fiance,  who 
broke  the  engagement.  Psychoanalytic  methods  now 
brought  it  to  full  clearness  that  she  had  her  first  attack  after 
selling  a  pair  of  gloves  and  fitting  them  to  the  hand  of  a 
male  customer  who  had  a  certain  similarity  to  her  fiance. 
It  was  not  possible  to  trace  this  in  the  same  way  for  later 
cases  too,  but  ft  seems  that  bodily  contact  with  a  man  by 
fitting  gloves  preceded  every  attack.  All  this  was  brought 
out  partly  by  questions,  partly  by  free  ascending  associations 
while  she,  herself,  believed  that  she  simply  pronounced  non- 
sense words  as  they  came  to  her  mind,  and  partly  it  was 
secured  in  a  half-hypnotic  state.  I  came  to  the  conclusion 
that  the  suppressed  sexual  emotions  at  the  breaking  of  the 
engagement  were  the  primary  cause  of  the  disease.  'The 
similarity  of  the  first  customer  together  with  the  tactual 
sensations  had  evidently  touched  that  complex  and  brought 
the  suppressed  emotion  to  an  explosion  which  frequently 
takes  the  form  of  palpitation  and  similar  symptoms.  Later 
the  mere  tactual  sensation  alone  produced  by  the  contact 
with  the  hand  of  a  man,  possibly  with  a  similar  optical 
impression,  perhaps  also  with  the  sound  of  the  voice,  brought 
back  the  reaction.  Instead  of  giving  treatment,  I  insisted 
that  she  change  stores,  and  become  saleswoman  in  a  house 
where  she  would  have  to  do  only  with  women,  and  to  sell 


274  PSYCHOTHERAPY, 

articles  which  did  not  bring  her  into  personal  contact  with 
customers.  After  more  than  six  months  of  work  in  her 
new  place,  she  reported  that  the  attacks  had  not  come  back 
again. 

Of  course  it  may  readily  be  acknowledged  that  this 
method  does  not  allow  a  sharp  demarcation  line  be- 
tween its  various  factors.  It  cannot  be  denied  that  an 
element  of  straight  suggestion  may  be  included.  The 
man  whom  I  train  in  the  forming  of  a  new  antagonis- 
tic motor  response  feels  it  of  course  all  the  time  also 
as  a  silent  suggestion  to  overcome  the  old  disturb- 
ance. It  is  thus  to  a  certain  degree  impossible  to  say 
where  the  effect  of  the  discharge  ends  and  where  that 
of  the  hidden  suggestion  begins.  Yet  there  certainly 
cannot  be  any  doubt  that  this  revival  of  the  first  ex- 
perience and  its  improved  discharge  works  directly  to- 
wards the  removal  of  the  troublesome  symptom. 

Abnormal  fear  is  also  the  essential  factor  in  most 
cases  of  stammering.  The  patients  usually  know  it 
themselves.  For  instance,  a  lawyer  writes  to  me : 

"  I  have  been  a  stammerer  the  greater  part  of  my  life 
and  have  visited  every  stammering  school  in  the  country, 
but  the  relief  obtained  has  been  temporary  and  in  most 
cases  I  was  not  benefited  at  all.  I  am  convinced  that  stam- 
mering is  due  wholly  to  an  abnormal  mental  condition, 
which  consists  of  an  unreasoning  fear  that  takes  possession 
of  the  individual  when  he  attempts  to  utter  certain  sounds. 
It  is  simply  a  lack  of  confidence  inspired  by  numberless  fail- 
ures to  articulate  properly  and  is  not  caused  by  any  organic 
trouble,  because,  taking  my  own  case  for  example,  I  can  at 
times  talk  as  fluently  and  easily  as  anyone.  I  am  firmly  con- 


THE  MENTAL  SYMPTOMS         275 

vinced  that  stammering  can  be  cured  by  hypnotic  suggestion. 
If  you  could  get  me  in  the  hypnotic  state  and  suggest  to  me 
repeatedly  that  from  thenceforth  I  would  have  easy  fluent 
speech,  I  feel  absolutely  certain  that  such  would  be  the 
case." 

Or  an  engineer  writes  to  me: 

"At  times  I  stammer  very  badly.  In  an  ordinary  con- 
versation it  is  scarcely  perceptible,  but  it  is  almost  im- 
possible for  me  to  make  an  explanation  or  relate  an  incident 
or  tell  an  anecdote.  I  began  to  stammer  when  I  was  about 
seven  years  of  age — I  am  twenty-nine  now — and  continued 
until  I  was  seventeen,  when  I  broke  myself  of  it  by  read- 
ing aloud.  It  came  back  on  me  about  a  year  ago,  at  which 
time  I  was  laboring  under  a  very  severe  nervous  strain  on 
account  of  business  matters.  I  have  since  tried  to  break 
myself  of  it  in  the  way  that  I  did  at  first,  reading  aloud, 
but  have  been  unable  to  do  so.  Can  it  be  cured  by  hypnotic 
treatment  or  suggestion?  Can  any  hypnotist  of  ordinary 
ability  do  it?" 

I  should  affirm  this  question,  which  is  one  of  the 
most  frequent  put  to  the  psychotherapist.  And  yet,  if 
I  myself  have  entirely  given  up  the  cure  of  stam- 
merers in  recent  years,  it  was  not  only  because  there 
was  little  chance  to  learn  anything  new  scientifically 
from  it  but  also  because  it  was  ultimately  disappoint- 
ing, as  the  severe  cases  cannot  be  cured  entirely. 
Every  hypnotist  can  quickly  secure  a  strong  improve- 
ment. In  even  new  cases  I  found  an  almost  sur- 
prising improvement  in  the  first  two  weeks,  an  im- 
provement which  stirs  up  the  most  vivid  hopes  of 
the  sufferers.  Then  the  improvement  becomes  slower 


276  PSYCHOTHERAPY 

and  finally  it  stops  before  a  complete  cure  is  reached. 
The  patient  notices  it  and  it  easily  works  back  on 
his  emotion  and  thus  begins  again  to  disturb  the 
speech,  unless  a  very  careful  continuous  counter-sug- 
gestion is  given.  Slight  disturbances,  to  be  sure,  can 
be  removed  entirely.  The  essential  point  will  always 
be  to  suggest  to  the  stammerer  the  full  belief  that  he, 
is  able  to  speak  every  word  and  that  he  is  able  to 
speak  it  in  every  situation.  But  where  there  is  a 
limit  for  improvement,  we  must  take  for  granted  that 
the  disturbing  fear  is  only  superadded  to  an  organic 
trouble.  In  such  cases,  probably  the  inability  of  cer- 
tain nervous  paths  was  primarily  irreparable.  These 
inabilities  then  became  the  source  of  discomfort  and 
of  fear  and  this  fear  added  greatly  to  the  disturb- 
ance. Hypnotism  then  quickly  removes  that  part  of 
the  disturbance  which  had  been  superadded  by  the 
mental  emotion  but  it  cannot  remove  that  primary 
factor,  the  objective  inability,  and  every  cure  thus 
finds  its  limit  there. 

Near  the  field  of  emotions  stand  also  the  many 
varieties  of  sexual  abnormities  and  perversities.  I 
abstain  from  discussing  any  special  cases  but  it  may  be 
said  that  suggestive  treatment  is  in  this  region  power- 
ful to  an  almost  surprising  degree.  Even  homo- 
sexual tendencies  which  go  back  to  the  beginnings 
of  the  memory  of  the  individual  yield,  as  my  experi- 
ence shows,  in  a  few  weeks,  if  again  the  suggestion  is 
not  so  much  directed  towards  the  suppression  as  to 
the  creation  of  the  antagonistic  reaction,  that  means 
in  this  case,  of  the  normal  sexual  desire. 


THE  MENTAL  SYMPTOMS         277 

Both  ideas  and  emotions,  of  course,  lead  to  actions. 
Moreover  we  always  insisted  that  the  resulting  action 
is  an  essential  part  of  the  psychophysical  situation 
and  that  every  mental  experience  has  to  be  character- 
ized as  a  starting  point  for  action.  Yet  this  factor  of 
activity  and  of  attitude  sometimes  stands  in  the  fore- 
ground. The  controlling  idea  is  then  the  idea  of  an 
end  of  action,  the  predominant  emotion,  the  emotion 
anticipated  from  a  certain  activity.  Typical  for  that 
are  those  disturbances  in  which  an  abnormal  impulse 
or  an  abnormal  desire  awakes  perhaps  a  desire  for 
ruinous  drugs  like  morphine  or  cocaine  or  an  impulse 
to  criminal  deeds,  like  stealing.  But  the  disturbances 
of  the  psychomotor  factor  are  not  less  present  when 
the  central  complaint  is  a  lack  of  energy,  the  most 
frequent  symptom  of  the  neurasthenic;  and  our  whole 
discussion  has  made  it  clear  that  a  mere  lack  of  at- 
tention belongs  to  the  same  category. 

Of  course,  the  abnormal  impulse  is  psychophys- 
ically  not  different,  whether  it  leads  to  a  legally  im- 
portant result  like  the  impulse  to  kill  or  leads  to  an 
indifferent  result.  The  subjective  suffering  may  be 
the  same  in  both  cases.  The  starting  point  of  the 
impulse  may  be  any  chance  experience.  The  psychas- 
thenic  may  pick  up  such  impulses  from  any  model 
for  imitation  or  from  any  haphazard  report.  It  may 
be  entirely  freakish  and  yet  beyond  conscious  control. 

A  physician  had  read  in  a  well-known  book  on  hysteria 
about  a  case  in  which  a  girl  was  troubled  by  a  constant 
effort  to  move  the  big  toe  in  her  shoes.  This  idea  worked 


278  PSYCHOTHERAPY 

on  him  as  a  suggestion  for  several  months.  At  my  advice  he 
fought  it  by  auto-suggestion.  He  brought  himself  into  a 
slightly  drowsy  state  by  staring  into  a  crystal  ball  and  assur- 
ing himself  by  spoken  sentences  with  monotonous  repetition 
for  a  long  while  that  he  has  perfectly  the  power  to  hold 
the  toe  at  rest.  From  the  second  day  only  a  slight  kinaes- 
thetic  sensation  remained;  the  movement  itself  disappeared. 

Or  a  more  unusual  case. 

A  young  lady  once  noticed  in  a  man  a  different  color  in 
the  two  eyes.  It  gave  her  an  uncanny  feeling,  together  with 
the  natural  impulse  to  compare  the  two  eyes.  Accordingly 
she  shifted  her  own  eyes  from  one  eyeball  to  the  other  in 
the  man's  face.  The  accent  which  this  shifting  impulse 
had  received  by  the  disagreeable  feeling  evidently  forced  her 
to  repeat  this  movement  with  everyone.  At  first  it  became 
half  a  play,  but  soon  a  disturbing  habit  and  finally  an  in- 
tolerable impulse.  Whenever  she  talked  with  anyone,  she 
lost  control  of  her  eyes  and  was  obliged  to  enter  into  a  kind 
of  pendulum  movement  from  eye  to  eye.  The  situation  be- 
came so  unendurable  that  the  thought  of  suicide  began  to 
'occur  to  her.  I  hypnotized  her  four  times,  suggesting  to  her 
complete  indifference  as  to  the  face  of  those  with  whom 
she  spoke  and  at  the  same  time  certain  new  habits  of  fixa- 
tion. The  impulse  lost  its  hold  and  when  I  saw  her  last,  it 
had  completely  disappeared. 

By  far  more  frequent  than  such  neutral  impulses 
are  the  desires,  for  instance,  of  the  alcoholist.  On 
the  whole  it  may  be  said  that  psychotherapy  can  gain 
its  easiest  triumphs  in  the  field  of  alcoholism  and  a 
wide  propagation  of  psychotherapeutic  methods  and 
of  a  thorough  understanding  of  psychotherapy  would 


THE  MENTAL  SYMPTOMS         279 

be  fully  justified,  even  if  no  other  field  were  accessible 
but  that  of  the  desire  for  alcoholic  intemperance. 
The  moral  disaster  and  economic  ruin  resulting  from 
alcoholic  intemperance,  the  physical  harm  to  the 
drinker  and  to  his  offspring  is  so  enormous,  and  the 
temporary  cure  of  the  victim  is  so  probable  that  the 
movement  certainly  deserves  most  serious  interest. 
Yet  I  speak  of  temporary  cure  and  I  refer  here  espe- 
cially to  the  restriction  with  which  I  introduced  the 
psychotherapeutic  methods  in  general.  They  do  not 
deal  with  diseases  but  with  symptoms;  and  they  cer- 
tainly do  not  deal  with  constitutions,  but  with  results 
of  the  cooperation  of  constitution  and  circumstances. 
That  the  given  constitution  may  be  brought  anew 
under  conditions  which  again  stir  up  similar  symp- 
toms is  always  possible,  and  just  with  alcoholism  the 
danger  lies  near  unless  beneficial  influences  remain  in 
power.  Certainly  no  one  has  a  right  to  neglect  such 
psychotherapeutic  aid  simply  because  relapses  are 
possible.  Even  a  temporary  relief  can  be  a  great 
blessing.  Moreover,  the  temporary  relief  is  the  saf- 
est basis  to  work  towards  the  prevention  of  a  recur- 
rence of  the  evil.  Only  in  two  directions  is  further 
restriction  needed.  Psychotherapeutic  methods  are 
in  my  opinion  of  very  small  avail  in  cases  of  periodic 
drinkers.  Such  periodic  attacks  of  patients  who  have 
not  even  a  desire  for  alcohol  in  intervals  between  the 
attacks,  intervals  which  may  last  a  quarter  of  a  year, 
are  related  to  epilepsy.  It  seems  that  constant  hyp- 
notic influence  during  the  interval  has  a  certain  power 
to  reduce  the  periodic  impulse.  I  personally  have  not 


28o  PSYCHOTHERAPY 

seen  any  special  improvement  from  it.  The  second 
restriction  would  be  that  the  drinker  has  to  be  under 
constant  supervision  during  the  first  days  of  hypnotic 
treatment.  No  patient,  not  even  the  morphinist,  is 
so  skillful  in  deceiving  his  friends  and  even  the  physi- 
cian. Even  the  most  emphatic  gestures  of  sincerity 
ought  to  be  distrusted. 

Only  a  short  time  ago  I  dealt  with  a  young  man  whom 
his  parents  and  a  chauffeur  had  accompanied  to  Boston,  ex- 
clusively for  the  purpose  of  watching  him  constantly  while 
I  was  to  attempt  to  cure  him  from  excessive  whiskey  drink- 
ing. The  chauffeur  accompanied  him  from  his  room  in  the 
Boston  hotel  to  the  threshold  of  my  laboratory.  All  through 
the  day  he  was  with  his  parents,  and  at  the  hotel  the  man- 
agement had  given  the  strictest  orders  not  to  sell  any  drink 
to  the  young  spendthrift.  He  was  an  earlier  student  of  mine 
and  had  attached  himself  to  me  with  such  an  apparent 
sincerity  as  removed  every  possible  doubt  of  his  pledge.  In- 
tentionally I  had  not  even  asked  him  for  a  pledge  not  to 
drink  but  only  for  a  pledge  to  confess  to  me  the  next  day 
if  he  ever  should  take  any  alcohol.  In  a  tentative  way  I 
suggested  to  him  in  a  half  hypnotic  state  on  the  first  day 
that  he  would  feel  disgust  for  whiskey.  I  did  not  expect 
much  of  an  improvement  before  at  least  thr*ee  or  four 
treatments.  I  was  therefore  most  surprised  when  he  most 
solemnly  assured  me  the  next  day  that  he  awoke  in  the 
morning  with  an  assured  feeling  that  he  should  never  touch 
whiskey  again  and  that  he  had  not  the  slightest  desire  for 
it.  Instead  of  a  systematic  development  of  suggestions,  I 
confined  myself  therefore  to  a  mere  repetition  of  the  treat- 
ment of  the  first  day  and  as  every  morning  the  same  assur- 
ance came  forth,  there  seemed  to  be  no  need  for  any  varia- 


THE  MENTAL  SYMPTOMS         281 

tion.  It  was  not  before  the  fifth  day  that  I  discovered  that 
he  had  taken  from  the  start  a  pint  of  whiskey  every  day. 
When  he  first  arrived  he  had  bribed  a  laundress  of  the 
hotel  to  bring  to  his  room  every  day  the  whiskey  hidden 
in  the  laundry  and  he  drank  it  during  the  night.  Then 
I  declined  any  further  participation. 

The  danger  of  deceit  is  of  course  less  imminent 
when  not  the  family  but  the  patient  himself  takes  the 
initiative.  Yet  even  here  distrust  is  wise.  The  pa- 
tient has  sometimes  the  most  sincere  intention  to  be 
cured,  but  under  pressure  of  his  craving  he  admits 
compromises  which  he  hides  from  the  physician. 
Having  reduced  the  large  quantity  of  alcohol  to 
which  he  was  accustomed,  he  hides  the  fact  that  he 
yet  takes  a  few  drinks,  which  he  thinks  cannot  prevent 
the  cure.  Yet  inasmuch  as  a  complete  cure  has  to 
rely  on  psychical  factors,  this  consciousness  of  de- 
ceiving even  with  small  transgressions  interferes 
badly  with  progress  and,  inasmuch  as  the  cunning- 
ness  of  the  patient  is  itself  a  symptom  of  the  disturb- 
ance, the  strongest  possible  precaution  is  advisable  at 
the  beginning.  For  that  reason  it  is  also  not  best  to 
begin  at  once  with  complete  prohibition,  but  to  lead 
to  a  total  abstinence  in  about  one  week.  But  certainly 
in  the  case  of  every  drunkard,  total  abstinence  is  the 
only  desirable  goal.  A  pronounced  drinker  ought 
never  to  be  transformed  simply  into  a  moderate  one. 
The  return  to  intemperance  would  result  rapidly.  On 
the  other  hand  it  would  be  unfair  to  deny  that  psycho- 
therapy has  cured  the  symptom  if  the  desire  really 
once  disappeared  completely,  even  if,  after  years, 


282  PSYCHOTHERAPY, 

new  temptations  develop  a  new  desire.  I  myself  had 
diphtheria  three  times  in  my  life;  my  constitution  is 
thus  probably  especially  favorable  to  that  disease  but 
I  do  not  estimate  less  the  fact  that  I  was  perfectly 
cured  the  second  time,  in  spite  of  the  fact  that  I 
caught  it  a  few  years  later  a  third  time.  To  be  sure, 
such  experiences  of  relapse  cannot  be  spared  any  psy- 
chotherapist. I  may  give  a  typical  instance. 

A  well-known  professional  man  of  fifty  years,  through 
a  long  bachelorhood,  was  accustomed  to  close  his  work  at 
four  o'clock  and  then  to  sit  comfortably  in  his  study  with 
a  book  and  an  unlimited  supply  of  brandy.  He  took  one 
cognac  after  another  and  every  evening  he  was  completely 
intoxicated.  He  married  a  young  wife  and  felt  the  need  of 
changing  his  habits,  the  more  as  he  himself  saw  symptoms 
of  his  excess  which  alarmed  him.  When  he  came  to  me, 
I  saw  that  he  was  seriously  wishing  to  give  up,  and  he  un- 
derstood himself  that  there  was  only  the  one  way,  namely, 
complete  abstinence.  He  felt  that  he  could  not  reach  it 
by  his  own  will  power  alone  and  sought  my  aid.  I  hyp- 
notized him  six  times,  suggesting  at  first  a  reduction  to 
four  drinks,  then  to  two,  then  to  one  and  then  to  pure 
mineral  water.  I  concentrated  my  effort  on  stirring  up 
the  antagonistic  attitude,  the  dislike  of  the  smell  of  brandy 
and  the  aversion  to  its  taste.  The  effect  was  excellent. 
After  the  fifth  time  the  mental  torture  which  he  had  felt 
in  the  first  afternoons  had  completely  disappeared.  I  con- 
sidered further  hypnotizing  superfluous  and  felt  sure  after 
the  sixth  time  that  the  man  was  cured.  For  about  a  year 
he  remained  abstinent,  but  in  the  meantime  his  professional 
life  brought  severe  disappointments,  and  with  cool  considera- 


THE  MENTAL  SYMPTOMS         283 

tion  he  decided  that  he  might  have  at  least  some  pleasure 
from  life  and  forget  its  miseries.  Accordingly  after  a  year 
he  determined  again  to  take  some  brandy  in  his  study,  and 
of  course,  that  led  rapidly  to  an  increase  of  the  dose  and 
today  he  is  probably  at  the  old  point.  And  yet  it  may  be 
said  with  correctness  that  psychotherapy  had  done  its  duty. 
If  at  the  right  moment  before  he  took  the  first  step  again, 
even  the  slightest  countersuggestion  had  been  applied,  the 
disastrous  second  development  could  have  been  easily 
avoided. 

My  experience  indicates  the  best  results  where  the 
suggestions  are  from  the  start  directed  as  much 
against  the  unfavorable  social  conditions,  with  their 
temptations  and  impulses  to  imitation,  as  against 
the  alcoholic  beverages  themselves.  On  the  whole  it 
is  easier  to  break  the  vicious  drinking  habits  of  the 
social  drinker  than  those  of  the  lonely  drinker,  a 
point  which  ought  to  be  well  considered  in  settling 
the  complex  problem  of  prohibition  versus  the  tem- 
perance movement. 

The  situation  of  alcoholism  repeats  itself  in  still 
more  ruinous  forms  with  morphinism  and  cocainism, 
vices  which  grow  in  this  country  to  an  alarming  de- 
gree. The  psychotherapeutic  treatment  of  such  drug 
habits  demands  much  patience  and  much  skillful  ad- 
justment to  the  psychological  conditions.  Its  general 
difference  from  the  treatment  of  alcoholism  is  given 
by  the  circumstance  that  any  too  rapid  withdrawing 
of  the  drug  is  certainly  dangerous,  if  the  organism  is 
adjusted  to  a  relatively  strong  dose.  On  the  other 
hand,  I  may  say  that  I  have  not  seen  a  single  case 


284  PSYCHOTHERAPY 

in  which  a  really  patient  and  insistent  treatment  of 
morphinism  has  not  been  successful,  even  if  the 
destructive  dose  of  forty  grains  a  day  had  become 
habitual.  The  condition  is  only  that  the  patient  him- 
self have  the  best  will,  a  will  which  yet  is  not  strong 
enough  to  win  the  fight  without  psychotherapeutic 
help.  But  no  one  ought  to  expect  that  the  psycho- 
therapist can  secure  miracles  like  some  of  the  pill 
cures  which  treat  the  drug  fiend  in  three  days.  More- 
over neither  physician  nor  patient  ought  to  believe 
that  the  worst  is  to  come  at  the  beginning.  On  the 
contrary,  it  is  the  end  which  is  hardest,  the  reduction 
of  the  small  dose  to  nothing.  As  illustration,  I  give 
an  extreme  case. 

A  man  who  was  formerly  station  master  on  a  railroad 
had  been  operated  on  in  a  hospital  after  an  accident,  and 
as  some  pain  in  the  hip  remained  which  disturbed  his  sleep, 
the  physician  of  the  hospital  gave  him  some  morphine  and 
provided  him  with  the  material  for  morphine  injection  after 
leaving  the  hospital.  Then  began  the  usual  story.  He  be- 
came more  and  more  dependent  upon  his  injection,  the  dose 
was  steadily  increased,  he  found  unscrupulous  physicians 
who  yielded  to  his  demand  for  morphine  prescriptions;  he 
lost  his  position  with  the  railway  by  the  growing  effects  of 
the  morphine  poisoning,  he  became  divorced,  sank  lower  and 
lower,  his  daily  dose  fluctuating  between  thirty-five  and 
forty  grains  a  day,  and  when  he  came  to  me,  he  presented  a 
picture  of  the  lowest  type  of  hopeless  manhood.  He  spent 
practically  the  whole  day  in  bed  and  was  only  able  to 
totter  slowly  along  with  a  cane.  He  assured  me  that  life 
was  hell  for  him.  He  could  not  sleep,  he  could  not  eat,  he 


THE  MENTAL  SYMPTOMS         285 

could  not  think,  he  had  made  up  his  mind  to  commit  suicide 
if  I  could  not  help  him.  I  foresaw  that  it  would  in  the 
best  case  demand  months  of  insistent  energy  to  make  a  man 
out  of  that  unfortunate  wreck.  He  had  gone  through  three 
different  morphine  cures  in  three  sanitariums  and  none  had 
helped  him,  and  every  physician  whom  he  had  consulted 
had  declared  his  case  as  beyond  any  physical  cure.  I  decided 
to  make  the  somewhat  disproportionate  sacrifice  of  time  in 
order  to  study  whether  even  such  an  extreme  case  of  mor- 
phinism is  accessible  to  psychotherapeutic  treatment.  Four 
months  later,  he  left  my  laboratory  looking  like  an  athlete, 
strong  and  vigorous,  joyful  and  energetic.  For  three  weeks 
he  had  not  received  any  morphine,  had  good  appetite,  slept 
well,  and  had  happily  married.  As  his  wife  was  a  trained 
nurse,  she  will  take  good  care  that  no  new  slip  shall  ever 
occur. 

There  was  nothing  remarkable  in  those  four  months  of 
treatment.  He  was  easily  hypnotized,  and  I  hypnotized  him 
at  first  every  day,  then  every  second  day,  then  every  week. 
It  was  without  difficulty  that  I  reduced  the  forty  grains  to 
about  six  grains  a  day.  Then  the  struggle  began.  To  test 
the  case  as  a  strictly  psychological  problem  I  left  the  effort 
entirely  to  his  own  will,  that  is,  I  did  not  deprive  him  of 
the  morphine  supply  but  left  the  regulation  in  his  own 
hands.  During  that  whole  winter  he  had  a  bottle  with  a 
thousand  morphine  tablets  standing  on  his  desk.  Thus  he 
would  have  been  entirely  able  to  satisfy  any  craving,  but  by 
his  own  will  he  followed  my  suggestions  and  never  took 
more  than  I  permitted.  It  meant  a  terrible  struggle.  The 
tortures  which  he  had  to  pass  through  were  perhaps  worse 
than  those  which  he  had  experienced  at  the  time  of  his  lowest 
downfall.  They  came  to  a  focus  when  he  tried  to  go  from 
five  grains  to  three  grains  a  day  and  then  again  when  he 


286  PSYCHOTHERAPY 

approached  half  a  grain.  From  there  he  had  to  move  to  a 
fourth  of  a  grain,  then  to  an  eighth,  and  even  that  had  still 
to  be  divided  into  four  different  doses  which  were  then 
reduced  to  three,  to  two,  and  finally  to  one  dose  and  ulti- 
mately to  injections  of  warm  water.  A  rapid  increase  in 
general  strength  and  a  return  of  appetite  for  food  began 
when  he  had  reached  the  five  grain  limit.  I  did  not  allow 
on  any  occasion  the  introduction  of  a  substitute.  On  the 
other  hand,  I  added  every  day  suggestions  covering  the 
various  secondary  symptoms,  especially  the  pains  in  the 
stomach  and  the  feelings  of  faintness  and  the  emotional  de- 
pression. 

There  is  no  doubt  that  under  favorable  conditions, 
especially  If  the  dose  of  morphine  is  not  too  strong, 
autosuggestion  can  bring  about  a  similar  effect.  A 
reduction  of  ten  per  cent,  every  week  can  be  carried 
through,  if  a  pledge  is  given  to  one's  self  in  a  drowsy 
state.  The  great  value  of  autosuggestion  showed  it- 
self not  seldom  in  the  fact  that  morphinists  who  had 
applied  to  me  by  mail  for  a  cure  in  the  mistaken  be- 
lief that  I  do  work  in  a  professional  way  for  payment 
and  who  got  from  me  a  written  reply  that  I  could 
not  receive  them,  but  that  they  can  help  themselves, 
wrote  to  me  that  my  letter  gave  them  strength  to 
reduce  their  dose  considerably. 

Quite  similar  is  the  situation  with  cocainism  or  with 
the  combination  of  morphine  and  cocaine  which  is  so 
frequent  nowadays  with  young  physicians.  I  have 
repeatedly  seen  cures  where  the  case  already  gave 
the  impression  of  insanity.  Again  I  give  a  rather 
extreme  case. 


THE  MENTAL  SYMPTOMS         287 

A  physician  had  acquired  the  habit  of  using  and  misusing 
cocaine  for  the  treatment  of  a  disease  of  his  nose.  The  habit 
grew  to  a  craving  for  cocaine  while  the  cocaine  itself 
poisoned  the  brain.  Acoustical  hallucinations  began;  he 
heard  voices  from  every  corner  of  the  room,  and  on  the 
street  the  voices  took  persecute ry  character.  He  connected 
them  with  his  brother  living  in  Europe,  heard  his  voice  in 
the  denunciations,  and  developed  a  pathological  system  of 
ideas  around  the  central  thought  that  his  brother  had  a  tele- 
pathic influence  on  him.  His  reason  succumbed,  he  lost 
all  consciousness  of  delusion,  and  believed  himself  really  to 
be  under  the  control  of  the  absent  brother.  When  he  came 
to  me  he  had  been  without  sleep  and  without  food  for 
several  days,  and  he  was  not  seeking  my  help  to  get  rid  of 
the  mental  disturbance  but  to  overcome  the  power  of  his 
older  brother.  He  did  not  connect  the  fear  at  all  with  his 
misuse  of  cocaine.  When  I  discovered  the  role  which  the 
cocaine  played,  I  determined  to  try  the  suggestive  influence, 
the  more  as  I  found  that  he  was  in  a  half-hypnotic  state  as 
soon  as  he  had  entered  my  room.  I  suggested  to  him  to 
sleep  and  to  take  food  and  to  reduce  the  cocaine  dose  by  a 
fourth.  The  next  day  he  was  an  entirely  different  man  by 
the  effect  of  ten  hours'  sleep  and  a  large  breakfast.  Now 
I  concentrated  my  efforts  on  the  reduction  of  the  cocaine. 
After  ten  days  of  hypnotic  treatment  he  gave  up  cocaine  en- 
tirely, after  three  weeks  the  voices  disappeared  and  slowly 
the  other  symptoms  faded  away.  The  pathological  idea  of 
the  telepathic  influence  lasted  a  while  after  the  voices  had 
gone  until  this  idea,  too,  yielded  to  suggestion.  It  still 
took  six  weeks  before  he  himself  felt  that  he  was  entirely 
normal. 

The  way  in  which  the  average  physician  nowadays 
neglects   the   simple   tool   of   suggestive   treatment, 


288  PSYCHOTHERAPY 

when  it  can  be  used  for  the  protection  of  society,  is 
perhaps  nowhere  so  reckless  as  in  the  case  of  the 
morphinist  and  cocainist.  To  give  a  typical  case  of 
this  neglect  I  may  mention  that  of  a  highly  intelligent 
young  man  who  had  been  in  the  habit  of  using  both 
cocaine  and  morphine  for  ten  years  when  at  his  own 
request  he  was  sent  to  a  New  York  hospital.  He 
had  been  taking  alternately  morphine  for  a  year  or 
two,  then  cocaine  for  a  year  or  two,  and  had  some- 
times alternated  and  sometimes  combined  both  in  an 
irregular  way.  When  he  entered  the  hospital  in 
May,  1908,  he  was  in  a  cocaine  period  and 
was  taking  the  enormous  dose  of  one  hun- 
dred and  eighty  grains  of  cocaine  every  day. 
In  the  hospital  they  withdrew  the  drug  altogether. 
During  the  first  weeks,  he  was  entirely  sleepless. 
They  energetically  refused  him  any  substitutes  and 
after  six  weeks  he  began  to  feel  comfortable.  He 
gained  steadily  in  weight  and  after  three  months, 
when  he  left,  he  had  gained  fifty  pounds,  felt  entirely 
comfortable,  and  seemed  in  all  respects  normal  again. 
Before  twelve  hours -had  passed  after  leaving  the 
hospital,  he  had  again  taken  thirty  grains  of  cocaine 
and  ten  grains  of  morphine,  and  this  dose  rapidly 
grew  until  after  a  few  weeks  it  again  reached  a  hun- 
dred grains  of  cocaine  and  up  to  sixty  grains  of  mor- 
phine a  day.  Then  came  the  complete  breakdown. 
If  that  man  in  the  last  two  or  three  weeks  of  the 
hospital  treatment,  when  he  felt  entirely  comfortable 
and  normal  and  had  gained  his  normal  weight,  had 
received  even  a  slight  suggestive  treatment  suppress- 


THE  MENTAL  SYMPTOMS         289 

ing  any  desire  for  cocaine  or  morphine,  he  would 
easily  have  been  saved.  To  let  such  a  man  after  a 
drug  career  of  ten  years  go  out  again  to  the  places  of 
his  old  associations,  where  the  desire  had  to  be  stirred 
up,  is  inexcusable  at  a  time  when  psychotherapeutics 
has  won  its  triumphs  in  this  field.  It  might  have  been 
sufficient  to  give  him  preventive  treatment  at  least 
for  the  first  three  days  of  his  freedom.  And  such  a 
case  is  typical  of  hundreds. 

The  overstrong  impulse  and  overstrong  desire  finds 
its  counterpart  in  the  abnormal  lack  of  energy  and 
lack  of  attention.  The  patient — and  it  is  especially 
the  neurasthenic  patient — has  lost  his  usual  strength, 
he  shrinks  from  every  undertaking,  he  cannot  decide 
upon  any  action,  he  needs  a  disproportionate  effort 
for  the  smallest  task,  and  cannot  concentrate  his  at- 
tention in  spite  of  his  best  will.  The  varieties  of  this 
lack  of  power  and  inertia  are  familiar  to  every  physi- 
cian. They  certainly  often  need  much  more  than 
merely  psychotherapeutic  treatment,  although  on  the 
physical  side  no  schematic  method  is  admissible.  The 
laziness  of  the  anaemic  needs  a  different  treatment 
from  the  laziness  of  the  exhausted  but  in  every  case 
psychological  factors  can  be  of  decisive  influence, 
whatever  the  physical  and  chemical  treatment  besides 
them  may  be.  A  few  letters  may  again  illustrate  the 
varieties.  Here  again  there  is  no  sharp  demarcation 
line  between  the  normal  and  the  abnormal.  Letters 
like  the  two  following,  for  instance,  are  hardly  let- 
ters of  patients.  They  show  a  variation  which  is 
still  entirely  within  normal  limits  and  yet  a  source 


29o  PSYCHOTHERAPY 

of  suffering;  it  is  a  disturbance  which  usually  can  be 
removed  by  psychotherapeutic  means. 

"  I  do  almost  everything  with  effort,  nothing  spontane- 
ously. I  have  been  writing  for  five  years  but  am  a  mood 
writer  of  the  worst  type.  The  mood  comes  at  such  uncer- 
tain times  that  I  seem  to  be  absolutely  at  the  mercy  of 
caprice.  This  might  not  in  itself  be  a  misfortune  but  writ- 
ing is  my  only  calling  and  I  suffer  the  proverbial  torments 
of  lost  spirits  when  I  am  idle.  The  necessity  of  driving  my- 
self to  every  piece  of  work,  aggravated  by  the  fact  that  my 
parents  allowed  my  constitutional  inertness  to  have  full  play, 
has  hitherto  prevented  me  from  forming  any  regular  habit  of 
labor.  I  am  now  thirty-eight.  Would  you  suppose  that  if 
I  kept  my  nose  to  the  grindstone  for  one,  two  or  three  years, 
I  might  yet  hope  to  work  with  some  ease  and  regularity? 
That  is,  if  I  compelled  myself  to  write  a  certain  number 
of  hours  every  day  as  a  discipline,  regardless  of  the  quality 
of  matter  I  produce,  is  there  any  probability  that  I  might 
ultimately  overcome  the  fearful  paralysis  that  so  often  grips 
my  faculties?  Can  constitutional  indolence  be  overcome 
by  determination?  I  put  in  a  little  time  on  a  couch  every 
day.  When  worried  I  get  neurasthenia  and  all  kinds  of 
phobias.  Just  now  I  am  afraid  to  look  at  the  newspapers 
on  account  of  the  cholera  in  St.  Petersburg,  and  I  have  seen 
the  time  when  I  found  it  difficult  to  drink  water  after  I 
had  boiled  it  myself." 

Also  the  next  man  is  familiar  to  all  of  us. 

"  Plainly  we  are  told  every  man  is  born  into  the  world 
to  fill  some  purpose,  or  at  least  be  of  some  benefit  to  him- 
self or  his  fellowmen.  For  some  reason  I  do  not  make 
friends  among  men.  I  have  not  the  zeal  or  ambition  to 


THE  MENTAL  SYMPTOMS         291 

carry  or  even  begin  a  conversation  that  will  interest  the  in- 
dividual man.  I  worry  a  great  deal.  I  have  never  been 
able  to  concentrate  my  mind  to  study  and  figure  out  prob- 
lems. I  can  read  them  zealously  but  apparently  do  not 
get  to  the  bottom  and  cannot  retain  what  I  do  read.  If 
I  could  just  get  hold  of  the  power  of  thinking  and  dig  out 
that  tangible  something  that  holds  me  back,  I  could  go  for- 
ward and  make  myself  what  I  know  I  should  be.  But  I  feel 
that  so  far  I  am  a  total  failure.  If  I  only  had  that  one 
great  gift,  the  power  of  concentration  and  will  power,  I 
would  make  what  I  so  much  desire,  a  success  of  myself." 

A  similar  effect  and  yet  psychologically  a  different 
condition  exists  where  the  lack  of  energy  results  from 
the  suggestive  power  of  the  opposite,  producing  a 
constant  indecision. 

"  I  am  thirty  years  old  and  nearly  all  my  life  since  child- 
hood I  have  been  fearfully  troubled  with  the  habit  of  in- 
decision and  regretting  whatever  I  do.  It  has  grown  into 
a  habit  so  fixed  that  at  times  I  am  fearful  of  losing  my 
mind.  I  feel  anxious  to  do  something  and  decide  to  do  it, 
then  as  soon  as  it  is  done,  I  nearly  go  wild  with  regrets  un- 
til I  have  to  undo  it,  if  possible,  and  then  only  to  regret 
that.  I  am  this  way  about  the  most  trifling  things  and 
about  the  most  serious.  I  can't  perform  any  duty  well.  In 
business  and  in  social  affairs,  it  is  always  with  me.  It  has 
me  in  its  clutches,  a  horrible  monster  dragging  me  down. 
My  friends  misinterpret  me  and  wonder  what  I  mean  by 
doing  so  when  all  the  time  I  want  to  do  what  is  for  the 
best  and  cannot  for  this  tyrant  who  is  ever  present  with 
me.  I  will  plod  for  hours  and  hours  at  a  time,  and  at  every 


292  PSYCHOTHERAPY 

turn   I  am  handicapped.     I  am   intelligent  naturally  and 
appear  a  perfect  fool." 

From  the  report  of  such  chronic  cases  we  may 
turn  to  the  acute  ones.  Here  a  characteristic  letter  of 
a  typical  neurasthenic  young  modern  poet. 

"These  are  my  plans  but  I  hardly  think  that  I  can 
carry  them  through,  although  perhaps  you  can  help  me  by 
suggestion.  I  have  the  feeling  that  through  the  whole  of 
last  year  my  development  did  not  go  forward  but  back- 
ward. It  is  as  if  by  a  mental  or  physical  overstrain,  my 
whole  personality  has  entered  into  a  transition.  I  have  no 
joy  in  life,  no  sensation  in  love,  no  satisfaction  in  labor.  My 
will  has  become  weak  where  it  was  strong.  I  am  lazy,  up 
to  an  absolute  dislike  of  everything,  while  I  have  been 
energy  itself.  Often  I  have  only  the  one  desire,  to  end  my 
life  from  mere  fatigue.  If  there  had  been  any  external 
reason  for  ending  my  life,  I  should  perhaps  have  done  it 
long  ago.  I  am  so  apathetic  that  I  no  longer  take  myself 
seriously.  My  successes  do  not  please  me;  the  idea  of  writ- 
ing anything  gives  me  anxiety.  I  have  become  less  resisting, 
more  sweet,  more  soft,  I  should  almost  like  to  say,  more 
feminine.  I  became  infatuated  with  a  girl,  simply  because 
I  knew  that  she  hates  all  men.  The  inaccessible  is  still  the 
only  thing  which  can  stimulate  me  somewhat.  I  have  even 
written  a  poem  on  her,  but  nothing  can  satisfy  me  in  love. 
I  consider  my  state  a  disease  of  the  will  as  a  result  of  nerv- 
ous exhaustion.  I  must  find  some  one  who,  with  kindly 
power,  reenforces  my  will  system.  I  need  a  strong  mind — 
it  may  be  a  man  or  a  woman.  It  would  even  be  possible 
in  the  latter  case  that  I  might  marry  her. 

Even  the  writing  of  this  letter  has  fatigued  me  so  much 
that  I  should  like  best  to  sleep.  In  moments  like  the  pres- 


THE  MENTAL  SYMPTOMS         293 

ent  I  should  like  best  to  throw  myself  down  on  the  street 
or  ...  quickly  .  .  .  sink  .  .  .  into  the  ocean.  (I  regret 
having  made  the  little  points.  They  look  as  if  my  expres- 
sions are  a  pose.)  Yet  there  are  moods  in  which  I  am  en- 
tirely normal  and  no  one  fancies  what  I  am  passing  through. 
I  have  even  become  superstitious  lately.  Are  there  perhaps 
beings  which  can  absorb  our  energy?  Perhaps  another  being 
has  drunk  up  my  energy." 

Authors  run  easily  into  such  states.  Here  is 
another. 

"  I  am  a  neurasthenic,  and  I  am  beginning  to  believe,  a 
professional  one.  My  object  in  writing  is  to  ask  concerning 
the  advisability  of  my  visiting  you  for  treatment.  I  am 
ready  to  take  the  next  train  if  you  say  the  word,  if  you 
believe  you  can  help  me.  It  seems  that  the  regular  practi- 
tioner, who  is  very  irregular,  cannot.  If  there  is  one  good 
doctor  I  have  not  consulted,  I  would  like  to  know  his 
name.  I  was  doing  editorial  work  in  X  and  broke  down. 
Still  the  doctor  said  that  if  I  liked  my  work,  I  should  go 
back  to  it  and  pitch  in.  I  did.  It  lasted  a  few  days  and 
then  I  had  to  give  up  altogether,  couldn't  grind  out  an- 
other word.  Then  to  another  doctor also  the  best 

in  the  city.  He  told  me  to  give  up  all  work,  which  I  did, 
and  then  I  went  on  a  farm  for  six  months.  That  did  not 
help  me  either.  Later  I  went  west  and  spent  some  time  in 
the  mountains.  I  felt  no  better  there.  Then  I  went  to 
Arizona  and  lived  in  a  tent  out  on  the  desert;  that  did  not 
help  me.  There  was  always  a  sensation  of  exhaustion  and 
any  physical  exertion  put  me  on  my  back,  even  when  it  was 
light  and  pleasant  exercise.  Then  I  went  to  California;  it 
did  me  little  good.  It  is  a  perfect  paradise  for  anyone  who 
has  not  got  neurasthenia.  I  still  have  not  got  myself  in 


294  PSYCHOTHERAPY 

hand.  I  cannot  do  or  say  or  write  just  what  I  wish,  and 
cannot  concentrate  my  thoughts.  To  try  to  read  a  book 
is  punishment  because  I  forget  as  fast  as  I  read."  And 
so  on. 

I  answered  him  certainly  not  to  come  but  tried  to  induce 
some  autosuggestions.  A  few  weeks  later,  he  wrote  me: 
"  Ever  since  you  wrote  me,  I  am  now  feeling  somewhat  im- 
proved." Yet  I  cannot  judge  how  far  the  improvement  be- 
longed to  the  psychical  factor  only,  inasmuch  as  I  had  ad- 
vised him  also  to  take  some  bromides.  The  really  effective 
treatment  would  have  been  heterosuggestion  and  I  had  no 
time  to  enter  into  the  case. 

Where  direct  suggestion  is  used,  the  effect  is  often 
surprising. 

A  young  lawyer  after  a  period  of  overwork  had  come 
to  a  state  of  complete  lack  of  energy.  He  could  not  find 
strength  to  write  a  letter  and  he  came  to  me  at  a  day  when 
he  did  not  see  any  way  but  suicide  open  for  himself.  He 
complained  that,  as  soon  as  he  began  to  grasp  a  thought,  it 
was  evaporating.  He  stared  absently  about  the  room  and 
felt  sure  that  he  would  never  again  achieve  anything.  He 
had  not  even  the  energy  to  read  the  newspaper.  I  hypno- 
tized him  three  times,  each  time  waking  in  him  the  pleasure 
in  a  definite  piece  of  work,  at  first  simply  in  a  novel  which 
he  was  to  read,  then  in  some  letters  which  he  was  to  write, 
and  then  in  his  professional  work.  There  was  always  an 
interval  of  three  days.  The  fourth  time  he  declared  him- 
self that  the  hypnotic  influence  was  unnecessary,  as  he  felt 
that  he  was  again  in  the  midst  of  his  work. 

As  a  rule  the  effect  is  a  much  slower  one,  but  if  all 
personal  factors  are  well  considered  and  especially 
physical  disturbances  are  excluded,  the  result  is  usu- 
ally satisfactory. 


THE  MENTAL  SYMPTOMS         295 

Very  different  from  such  neurasthenics,  of  course, 
Is  the  lack  of  attention  in  the  feeble-minded,  and  sug- 
gestion of  the  ordinary  type  is  hardly  advisable, 
but  it  is  surprising  how  much  can  be  reached  by  a 
systematic  psychical  regime.  I  give  one  typical  in- 
stance, representative  of  many. 

A  boy  of  twelve  years  when  he  was  brought  to  me  showed 
the  mental  powers  of  a  stupid  child  of  four.  In  a  silly  way 
he  repeated  every  question  which  he  heard  without  answer- 
ing it ;  he  talked  steadily  to  himself  in  a  nonsensical  manner, 
mostly  repeating  nursery  rhymes  without  end,  never  hold- 
ing his  attention  to  anything  in  the  room,  giving  the  im- 
pression that  there  was  no  attention  whatever.  The  boy 
was  a  child  of  rich  parents;  he  had  his  own  teachers,  but 
was  for  a  large  part  of  the  year  under  the  influence  of  the 
parents  only,  who  very  naturally  yielded  to  every  desire  of 
the  unfortunate  child.  I  insisted  on  a  complete  change  of 
the  education.  It  was  my  effort  to  build  up  the  mind  by  a 
rigorous  training  and  by  development  of  the  power  of  in- 
hibition. I  absolutely  forbade  any  meaningless  material  like 
the  nursery  rhymes,  insisted  that  the  child  should  never  be 
allowed  to  talk  to  himself,  and  whenever  he  began  to  speak 
to  himself  he  was  to  be  addressed  sharply,  and  if  he  yet  went 
on,  to  be  slapped  on  his  hands.  In  the  same  way  he  was 
not  allowed  to  repeat  a  question,  but  the  question  was  re- 
peated until  he  answered  it,  the  question  always  formulated 
in  simple  words.  He  was  forced  to  go  through  simple  read- 
ing and  writing  without  being  allowed  to  make  his  silly  di- 
versions. His  whole  life  was  brought  under  strict  discipline 
and  no  parental  indulgence  was  permitted.  Six  months 
later  the  child  was  completely  changed.  It  seemed  as  if 
he  had  gone  through  an  improvement  of  three  years.  I 


296  PSYCHOTHERAPY 

regulated  the  whole  of  his  elementary  studies  in  accordance 
with  the  successful  principle.  The  training  of  inhibition 
stood  in  the  foreground  and  every  haphazard  reaction  was 
severely  rebuked.  The  summer  vacations  spent  with  the 
parents  in  the  fashionable  surroundings,  to  be  sure,  had  al- 
ways a  retarding  influence,  but  the  main  part  of  the  year 
in  which  it  was  possible  to  carry  through  the  strict  discipline 
showed  such  steady  and  inspiring  progress  that  the  boy, 
while  of  course  feeble-minded  for  life,  can  yet  live  exter- 
nally a  harmonious  life. 

A  systematic  training  of  the  power  of  inhibition 
is  indeed  the  fundamental  factor  in  all  psy- 
chotherapeutic  treatment  when  the  disturbance 
is  in  the  volitional  sphere,  but  the  inhibition 
is  secured  most  safely  by  reenforcement  of 
the  antagonistic  attitude.  From  these  voli- 
tional variations  on  the  one  side,  from  the  ideational 
disturbances  on  the  other,  only  a  few  steps  lead  to 
those  dissociations  of  the  personality  which  are  char- 
acteristic of  many  graver  cases  of  hysteria.  But  to 
give  to  them  any  adequate  analysis,  it  would  be  in- 
sufficient to  refer  in  this  brief  way  to  particular  cases. 
Psychopathological  literature  possesses  some  excellent 
analyses  of  such  complex  disturbances.  As  I  said 
before,  I  abstain  entirely  here  from  such  complex 
phenomena,  as  they  enter  too  seldom  into  the  sphere 
of  the  practitioner  and  as  the  bewildering  manifold- 
ness  of  their  symptoms  does  not  allow  us  so  easily  to 
recognize  the  fundamental  principles  which  alone 
were  to  be  illustrated  by  our  short  survey  of  practical 
cases. 


XI 

THE  BODILY  SYMPTOMS 

THE  discussion  of  the  bodily  symptoms 
which  may  yield  to  psychotherapeutic 
treatment,  naturally  forms  only  a  short 
appendix  to  our  discussion  of  the  mental  symp- 
toms. Our  interest  was  from  the  beginning 
essentially  a  psychological  one.  I  shall  have  to  be 
the  more  brief  as  my  personal  experience  in  the  treat- 
ment of  bodily  diseases  through  mental  therapy  is 
entirely  secondary  and  accidental.  The  psycho- 
logical laboratory  would,  of  course,  be  an  entirely  un- 
fit place  to  struggle  with  diseases  of  which  the  chief 
symptoms  are  not  psychophysical.  Yet  in  spite  of 
frequent  testimonies  of  well-known  physicians  to  the 
contrary,  I  am  still  inclined  to  think  that  this  is  also 
the  situation  at  large.  I  think  that  in  medicine  in 
general  the  psychophysical  effect  of  mental  treatment 
is  by  far  more  important  and  by  far  more  extended 
than  the  healing  effect  on  diseased  peripheral  organs. 
Of  course  these  peripheral  parts  of  the  body  may  be 
favorably  influenced  in  an  indirect  way  by  the  men- 
tal treatment;  we  shall  have  to  take  notice  of  this 
important  result  but  that  is  strictly  not  a  therapeutic 
effect  on  the  bodily  symptoms.  Moreover,  purely 

297 


298  PSYCHOTHERAPY, 

psychical  effects  may  give  an  impression  as  if  the 
bodily  symptom  itself  has  been  removed. 

To  begin  with  the  latter  case,  it  is  especially  the  in- 
hibition of  pain  which  easily  makes  one  believe  that  a 
bodily  disturbance  is  successfully  treated.  I  have 
repeatedly  seen  cases  in  which  I  tried  by  suggestion 
to  soften  the  pain  resulting  from  a  peripheral  disturb* 
ance  like  inflammations,  rheumatism,  decayed  teeth 
and  so  on.  The  effect  was  often  such  a  total  disap- 
pearance of  the  pain  that  the  patient  himself  was  in- 
clined to  believe  that  the  objective  disease  had  been 
ended,  while  in  reality  the  state  of  the  diseased  organ 
was  not  changed  at  all.  It  has  often  happened  that 
I  tried  to  cure  a  person  of  certain  mental  symptoms 
by  suggestion,  ignoring  entirely  the  existence  of  some 
pain  resulting  from  a  bodily  disease  with  which  I 
had  nothing  to  do.  Yet  the  suggestion  of  improve- 
ment seemed  almost  to  irradiate  and  the  pain  dis- 
appeared in  spite  of  having  been  ignored  by  the 
hypnotizer.  For  instance,  I  treated  a  woman  who 
suffered  from  psychasthenic  obsessions,  fearing  all 
the  time  that  something  would  happen  to  her  child. 
I  did  not  give  any  direct  attention  to  the  fact  that 
she  had  had  for  years  a  painful  disease  of  the  bladder 
for  which  she  was  constantly  treated  by  a  specialist. 
But  while  I  did  not  mention  the  bladder  in  my  hyp- 
notic suggestion,  yet  the  abdominal  pain  disappeared 
together  with  the  obsession  and  the  situation  might 
easily  have  suggested  that  the  bladder  trouble  was  a 
nervous  one  which  had  been  cured  by  the  hypnotic 
sleep.  The  fact  was  that  the  bladder  disease  was 


THE  BODILY  SYMPTOMS  299 

not  influenced  by  the  mental  treatment  at  all,  and 
needed  a  continuation  of  the  same  local  treatment. 
It  was  only  the  psychophysical  pain  in  the  brain 
which  had  been  inhibited. 

Quite  parallel  to  the  disappearance  of  the  organic  -Jv^ 
pain  sensation  is  the  arising  of  a  general  feeling  of  \(L> 
improvement.  This  organic  sensation  of  general  j)^->  j^V 
betterment  may  again  be  a  strictly  mental  occurrence 
without  any  objective  reference  to  a  real  improve- 
ment in  the  bodily  conditions.  Yet  again  that  easily 
gives  the  impression  of  an  important  change  in  the 
bodily  conditions  themselves.  The  miraculous  cures 
of  various  diseases  through  mystic  agencies  generally 
belong  to  this  category.  There  is  no  doubt  that 
often  the  migrating  charlatans  who  advertise  them- 
selves by  a  free  treatment  of  the  sick  and  invalids  on 
the  theater  stage  of  small  towns,  produce  momentary 
effects  which  are  sufficient  to  deceive.  The  quack 
handles  the  diseased  organ,  perhaps  a  goiter  or  a  leg 
crippled  by  rheumatism,  with  a  cruel  rudeness  and 
overwhelms  the  suggestible  mind  so  completely  that 
the  first  autosuggestion  is  that  of  a  complete  change,  i 

and  that  means  cure.     The  disastrous  results  follow  \  \ 

later.  But  from  such  barbarisms  we  come  by  grad-  V  .  o° 
ual  steps  to  the  suggestion  of  improvement  where  the 
feeling  of  betterment  can  be  in  itself  an  important 
factor  for  the  cure.  Yet  even  there  we  must  not 
mistake  the  possible  secondary  effect  of  a  mental 
change  from  a  psychotherapeutic  cure  of  the  bodily 
disease. 

Not  seldom  the   removal   of  physical  disability 


3oo  PSYCHOTHERAPY, 

seems  secured  as  soon  as  certain  mental  disturbances 
are  removed.  There  is  no  reason  to  believe  for  in- 
stance that  suggestion  can  have  an  important  influ- 
ence on  a  diseased  sense  organ,  and  yet  hypnotic  in- 
fluence and  even  autosuggestive  influence  can  under 
certain  circumstances  greatly  improve  seeing  and 
hearing.  Especially  in  the  field  of  hearing  the  cen- 
tral factor  is  of  enormous  importance.  Hyperaemic 
and  anaemic  conditions  in  the  brain  centers  of  hearing 
control  the  vividness  of  the  received  sound.  The 
patient  who  cannot  hear  a  certain  watch  more  than 
*}  '  one  foot  distant  may  be  able  to  hear  it  after  some 

glasses  of  wine  at  a  distance  of  three  or  four  feet. 
Thus  it  is  only  natural  that  a  hypnotic  influence  can 
produce  similar  changes  on  the  psychophysical  cen- 
ters in  such  cases  in  which  the  source  of  the  trouble  is 
a  psychophysical  laziness  in  the  acoustical  center. 
Sometimes  even  this  laziness  itself  is  the  result  of 
psychical  autosuggestion  which  can  be  fought  by 
countersuggestion.  I  saw,  for  instance,  a  distinct 
improvement  in  hearing  in  the  case  of  a  young 
woman  who  had  increasing  deafness  while  the  aurists 
declared  that  the  ears  were  in  proper  condition.  I 
found  that  she  lived  with  a  father  who  suffered  from 
a  severe  middle-ear  catarrh  and  that  she  was  simply 
controlled  by  a  hidden  fear  that  she  might  have  in- 
herited the  ear  disease  of  her  father.  I  removed 
this  fear,  partly  by  reasoning,  partly  by  suggestion, 
and  partly  by  tricks  which  surprised  her,  for  instance, 
making  her  hear  her  watch  with  unaccustomed 
strength  when  she  took  it  between  her  teeth  and 


THE  BODILY  SYMPTOMS          301 

closed  both  ears.  The  autosuggestive  fear  was  up- 
rooted by  these  and  the  central  ear  organs  slowly 
came  to  normal  functioning. 

The  purely  psychical  character  is  still  more  evi- 
dent in  the  frequent  hysterical  anaesthesias.  No  one 
doubts  that  here  the  sensations  are  inhibited  only 
and  that  the  mental  influence  removes  this  inhibition 
without  any  influence  on  the  sense  organs  proper. 
Frequently  also  organic  troubles  like  stomach  diseases 
appear  cured  when  in  reality  hysterical  disturbances 
are  at  the  bottom.  The  stomach  may  be  sensitive  to 
any  pressure  and  may  produce  severe  pains  and  vom- 
iting on  taking  any  food  and  everything  may  in- 
dicate a  serious  local  disturbance.  Yet  hypnotic 
treatment  may  quickly  remove  the  symptoms  because 
the  whole  reaction  may  have  resulted  from  the 
shock  which  perhaps  a  too  hot  piece  of  potato  caused. 
The  removal  of  this  mental  starting  point  results  in 
a  cure  of  the  apparent  stomach  disease.  Again  in 
other  cases,  the  appearance  of  a  physical  cure  is  given 
by  the  creation  of  psychophysical  substitutes.  I  do 
not  believe  that  hypnotism  or  suggestive  treatment 
can  influence  the  brain  parts  which  have  suffered 
from  a  hemorrhage.  Yet  the  paralysis  of  the  arm, 
for  instance,  which  resulted  from  such  a  breaking  of 
a  blood-vessel  in  the  brain  may  be  to  a  high  degree 
repaired  by  building  up  new  motor  images  in  the 
psychophysical  system,  which  become  starting  points 
for  a  new  learning  of  movements.  The  patient  did 
not  understand  how  to  make  the  most  out  of  those 
motor  paths  which  had  been  left.  The  destruction 


302  PSYCHOTHERAPY, 

of  the  chief  channels  of  discharge  had  inhibited  in  his 
mind  the  idea  of  possible  movement.  He  no  longer 
believes  that  he  can  move  and  it  needs  new  sug- 
gestions to  overcome  this  inhibition.  The  curative 
effect  on  bodily  disabilities  is  thus  often  an  illusory 
one. 

That  does  not  mean  that  the  field  in  which  psycho- 
therapeutics  may  work  directly  on  the  body  is  not 
after  all  a  large  and  interesting  one.  Theoretically 
it  is  still  little  open  to  real  understanding.  The  ex- 
planation has  essentially  to  rest  on  the  acceptance  of 
ra  given  physiological  apparatus.  A  certain  psycho- 
physical  excitement  produces  by  existing  nerve  con- 
nections a  certain  effect,  for  instance,  on  the  blood- 
vessels or  on  the  glands  of  a  certain  region,  or  on  a 
certain  lower  nervous  center.  That  such  apparatus 
exists,  the  physiological  experiment  with  persons  who 
are  hypnotized  to  a  high  degree  can  easily  demon- 
strate. Their  nose  bleeds  at  a  command;  a  blister 
may  arise  on  a  part  of  the  skin  which  is  simply 
covered  with  a  penny,  when  the  suggestion  is  given 
that  the  penny  is  glowing  hot.  With  some  subjects, 
the  pulse  can  become  slower  and  quicker  in  accord- 
ance with  the  suggestion;  with  some  even  the  bodily 
temperature  can  change  on  order.  Our  understand- 
ing of  these  indubitable  facts  indeed  does  not  go  fur- 
ther than  the  acknowledgment  that  the  paths  for  such 
central  connections  exist.  That  means  we  simply 
describe  the  facts  once  more  in  the  terms  of  anatomy. 
But  after  all  in  the  same  way  we  rely  on  the  nervous 
connections,  if  a  thought  makes  us  blush  and  ulti- 


THE  BODILY  SYMPTOMS          303 

mately  if  our  will  moves  our  arm  or  if  our  ideas  move 
our  speech  apparatus.  We  do  not  choose  the  muscles 
of  our  arm,  we  hardly  know  them ;  we  know  still  less 
in  speaking,  of  the  movements  of  our  vocal  cords, 
and  in  blushing  of  the  dilated  blood-vessels.  That 
ideas  work  on  the  lower  centers  of  our  central  nerv- 
ous system,  centers  which  regulate  the  actions  of  our 
muscles  and  blood-vessels  and  glands,  must  simply  be 
accepted  as  the  machinery  of  our  physiological 
theory.  The  connection  of  such  theories  with  purely 
physical  facts  is  given  by  the  experience  that  an  elec- 
trical stimulation  of  the  nerve  may  have  the  same 
influence  as  ideas.  The  electric  current,  too,  can 
regulate  the  beat  of  the  heart,  or  contract  and  dilate 
the  vessels,  or  reenforce  and  relax  the  contraction  of 
the  muscles,  or  strengthen  and  weaken  the  functions 
of  the  glands. 

Nearest  to  the  psychophysical  processes  stands  the 
bodily  symptom  of  insomnia.  There  is  no  doubt 
possible  that  the  work  of  the  psychotherapist  can  be 
very  beneficial  in  producing  sleep  by  suggestion. 
That  autosuggestions  for  sleep  play  an  important 
role  is  popularly  accepted.  Next  to  the  most  im- 
mediate means  such  as  lying  down,  or  cutting  off 
sense  stimuli,  or  trying  not  to  think,  or  avoiding 
movements,  certainly  the  most  well  known  factor  is 
the  expectation  of  sleep  with  the  belief  that  sleep 
will  come.  This  belief  may  be  reenforced  to  strong 
autosuggestion  which  may  then  overcome  other  fac- 
tors that  hinder  sleep.  For  instance,  I  have  re- 
peatedly received  letters  from  strangers  containing 


3o4  PSYCHOTHERAPY 

expressions  of  gratitude  with  news  which  under  other 
circumstances  would  at  least  not  flatter  an  author. 
They  wrote  to  me  that  immediately  after  reading 
one  or  another  essay  of  mine  on  hypnotism,  they  fell 
into  deep  sleep.  Yet  as  they  were  always  patients 
who  had  suffered  from  insomnia,  I  was  pleased  with 
this  unintended  effect  of  my  writings.  But  in  most 
cases  a  real  cure  demands  heterosuggestion. 

There  is  room  for  any  variety  of  effects;  often 
they  enter  immediately.  The  other  day  I  gave  sleep 
suggestion  to  a  young  woman  who  had  overworked 
herself  in  literary  production.  For  months  she  had 
not  slept  more  than  three  or  four  hours  a  night  and 
even  that  only  after  taking  narcotics.  I  intentionally 
did  not  allow  her  to  come  into  a  hypnotic  sleep  but 
kept  her  fully  awake,  increasing  her  suggestibility 
while  her  eyes  were  wide  open.  I  suggested  to  her 
to  take  a  walk,  then  to  eat  her  dinner,  and  after  that 
to  go  to  bed  at  once.  She  went  to  bed  at  seven 
o'clock  and  slept  without  waking  until  ten  o'clock  the 
next  morning,  and  after  fifteen  hours'  sleep  she  was 
like  a  different  being.  A  regular  eight  hour  sleep  is 
sometimes  secured,  even  where  no  immediate  direc- 
tion has  been  given  for  it.  On  the  other  hand,  I  can- 
not deny  that  I  have  sometimes  been  entirely  un- 
successful in  securing  better  sleep  by  the  first  three 
hypnotic  treatments.  When  the  first  three  treat- 
ments were  unsuccessful,  I  always  gave  it  up  on  ac- 
count of  lack  of  time.  Yet  the  experience  of  others 
shows  that  in  such  cases,  often  after  a  long  continued 
hypnotic  treatment  insomnia  yields  to  suggestion. 


THE  BODILY  SYMPTOMS          305 

One  of  the  great  factors  which  work  against  the 
mental  treatment  is  the  habit  of  so  many  sufferers  of 
relying  on  their  sleeping  powders  which,  to  be  sure, 
remain  effective  only  by  increasing  the  dose  and  thus 
finally  by  making  them  dangerous.  Every  chemical 
narcotic  has  in  itself  suggestive  power  and  strength- 
ens the  belief  of  the  sleep-seeker  that  he  cannot  find 
rest  without  his  dose.  To  overcome  the  monopoly 
of  the  opiates  is  one  of  the  most  important  functions 
of  psychotherapy. 

It  is  not  surprising  that  the  relations  of  psycho- 
therapy to  sleep  show  such  a  great  variety.  The 
factors  which  cooperate  in  normal  sleep  are  many 
and  the  disturbance  can  have  very  different  character. 
We  had  to  speak  of  the  psychophysics  of  sleep  when 
we  discussed  the  theoretical  relation  of  sleep  to  hyp- 
notism and  insisted  that  it  is  misleading  to  consider 
hypnosis  simply  as  partial  sleep.  We  claimed  a 
fundamental  difference  between  the  selective  inhibi- 
tion in  hypnotism  and  the  general  reduction  of  func- 
tions in  sleep.  To  understand  sleep,  we  have  to 
recognize  it  as  one  of  the  fundamental  instincts,  com- 
parable with  the  instinct  for  food  or  for  sexual  satis- 
faction. Every  one  of  such  instincts  has  a  circular 
character.  Mental  processes,  subcorticaf  processes, 
and  physical  effects  are  involved  in  such  a  way  that 
each  reen forces  the  others.  The  physical  effect  of 
the  sleep  instinct,  comparable  with  the  pepsin  secre- 
tion in  the  food  instinct,  or  with  the  hyperaemia  of  the 
sexual  organs  in  the  sexual  instinct,  is  a  change  in  the 
cortex  by  which  the  sensory  and  motor  brain  centers 


3o6  PSYCHOTHERAPY 

are  put  out  of  action.  What  kind  of  a  change  that  is, 
is  quite  indifferent.  It  may  be  a  chemical  one  but 
more  probably  it  is  a  circulatory  one.  Let  us  say  it  is 
a  contraction  of  blood-vessels  which  by  the  resulting 
anaemia  makes  the  sensory  centers  unfit  for  perception 
and  the  motor  centers  unfit  for  action.  In  this  way 
the  brain  becomes  protected  by  sleep  against  the  de- 
mands of  the  surroundings.  The  mental  reactions 
are  eliminated  and  the  central  nervous  substance  has 
an  opportunity  to  build  itself  up.  This  protective 
physical  activity  is  now  evidently  itself  controlled  by 
a  subcortical  center,  just  as  secretion  and  sexual 
hyperaemia  are  controlled.  This  center  probably 
lies  in  the  medulla  oblongata. 

Some  theorists,  to  be  sure,  are  inclined  to  think 
that  the  fatigued  brain  cells  enter  directly  through 
their  exhaustion  into  the  protective  sleep  state-.  But 
that  simplifies  the  situation  too  much.  It  is  quite 
true,  as  these  theorists  claim,  that  monotonous  stimu- 
lation of  the  senses  produces  sleep.  But  it  is  evident 
.that  the  sleep  occurs  even  then  not  only  in  the  par- 
ticular overtired  brain  cells.  A  monotonous  stimula- 
tion of  the  acoustical  center  raises  the  threshold  of 
perception  for  all  the  senses  and  brings  sleep  to  the 
whole  brain.  This  control  of  the  whole  apparatus  is 
thus  surely  regulated  by  one  definite  center.  But 
this  lower  center,  which  controls  the  anaemia  of  the 
cortex,  is  itself  directly  dependent  again  upon  a  men- 
tal condition,  the  mental  experience  of  fatigue.  The 
fatigue  sensation,  which  is  possibly  the  result  of  toxic 
processes,  works  on  that  lower  sleep  center,  just  as 


\ 


THE  BODILY  SYMPTOMS          307 

the  appetizing  impression  or  the  sensual  images  work 
on  the  centers  of  the  other  two  instincts.  On  the 
other  hand  this  protective  blood-vessel  contraction 
creates  again  as  in  the  other  cases  a  characteristic 
organic  sensation,  the  sensation  of  rest  which  arises 
when  the  threshold  of  perception  and  activity  is 
raised.  The  world  begins  to  appear  dim  and  far 
away,  no  impulse  for  action  excites  us.  This  organic 
feeling  of  rest  associates  itself  with  the  fatigue  feel- 
ing. The  fatigue  ^sensation,  the  subcortical '/sleep 
center,  the  contraction- of  the  vessels  in  the  cortex, 
and  finally  the  rest  "sensation  form  together  the  com- 
plete circle.  The  difficulty  which  arises  in  this  case 
lies  only  in  the  fact  that  the  cortex  gone  to  sleep  an- 
nihilates also,  of  course,  the  fatigue  sensation  and 
the  rest  sensation.  For  that  reason  the  real  circle 
can  appear  only  in  the  preparatory  stages  of  sleep. 
As  soon  as  sleep  itself  sets  in,  the  circle  is  broken. 
The  circle  character  of  every  instinct  must  lead  the 
physical  effect  upward  to  a  higher  and  higher  degree. 
Not  to  become  excessive,  the  physical  effect  must  be 
checked  somehow.  In  all  other  spheres,  it  finds  its 
end  in  satisfaction,  for  instance,  by  eating  or  by  the 
sexual  act.  In  sleep  the  circular  process  ends  auto- 
matically by  its  own  effect  as  soon  as  complete  sleep 
is  reached.  Its  causes,  the  fatigue  and  the  rest  feel- 
ing, are  stopped,  as  soon  as  the  effect,  the  anaemia,  is 
secured. 

We  see  now  how  widely  different  starting  points 
can  lead  to  sleep  and  can  understand  from  it  how 
widely  different  disturbances  can  prevent  sleep. 


3o8  PSYCHOTHERAPY 

Sleep  must  result  when  fatigue  is  coming,  but  sleep 
must  also  result  when  the  elements  of  the  rest  feeling 
are  produced,  and  as  we  saw  that  the  components  of 
the  rest  feeling  were  the  sensations  of  decreased 
sensitiveness  and  decreased  activity,  sleep  must  result 
when  either  the  sensations  and  associations  are 
absent  and  actions  are  suppressed,  or  when  monot- 
onous sensations  and  automatic  actions  raise  the 
threshold.  Sleep  must  arise  further  if  our  will  as- 
sociates the  mere  idea  of  such  rest,  and  finally  phys- 
ical or  chemical  means  may  produce  a  sleep  bringing 
effect  either  on  the  lower  center  or  on  the  blood- 
vessels and  cells  of  the  cortex.  Correspondingly 
sleep  may  be  prevented  by  disturbances  in  any  one  of 
these  spheres.  There  may  be  no  normal  fatigue, 
there  may  be  no  fatigue  sensation,  there  may  be  no 
rest  feeling  on  account  of  perceptions,  or  on  account 
of  associations,  or  on  account  of  impulses  to  action; 
there  may  be  no  normal  response  in  the  sub-cortical 
center,  there  may  be  no  physical  effect  in  the  cortex 
on  account  of  an  existing  hyperaemia  or  on  account  of 
an  abnormal  condition  of  the  cells.  The  psycho- 
therapeutic  treatment  must  carefully  analyze  which 
element  would  be  fit  to  supply  the  last  link  in  the 
circular  chain.  Sometimes  we  need  the  suggestion 
of  fatigue,  sometimes  the  inhibition  of  ideas,  some- 
times the  suppression  of  impulses,  sometimes  the  sug- 
gestion of  rest,  and  so  on.  A  mere  general  sug- 
gestion of  sleep  is  on  the  whole  effective  only  in  the 
cases  of  those  persons  in  whom  this  idea  in  itself 
awakens  those  various  components.  Very  often  it 


THE  BODILY  SYMPTOMS          309 

is  entirely  ineffective  in  this  general  form.  Some- 
times it  is  possible  to  carry  the  hypnotic  state  itself 
directly  over  into  sleep,  but  it  seems  more  in  the  in- 
terest of  the  patient  to  separate  those  two  states 
distinctly. 

We  are  still  confined  to  processes  in  the  brain  itself 
if  we  turn  to  headache.  If  it  were  only  a  question 
of  inhibiting  the  pain  by  mental  suggestion,  the  case 
would  not  be  different  from  inhibiting  the  pain  of  a 
peripheral  organ  without  attempting  to  cure  the  dis- 
eased organ  itself.  But  in  the  case  of  headaches,  it 
seems  justified  to  claim  that  in  certain  varieties  of 
this  multifold  symptom,  not  only  the  pain  is  sup- 
pressed but  the  disturbance  itself  is  removed.  Es- 
pecially where  the  headache  seems  to  result  from 
hyperaemia,  the  trouble  seems  to  be  accessible  to  psy- 
chotherapeutics.  On  the  other  hand  I  have  never 
seen  any  lasting  effect  on  the  so-called  sick  headache 
or  migraine.  While  continuous  headaches  or  head- 
aches which  occur  daily  yielded  to  my  influence, 
sometimes  completely,  I  was  unable  to  prevent  even  V 
by  preparatory  hypnotization  any  migraine  which  ap- 
pears periodically,  for  instance,  simultaneously  with 
menstruation. 

A  few  words  only  as  to  the  general  diseases  and 
disturbances  for  which  a  very  strong  therapeutic  effect 
has  been  claimed  by  masters  of  the  craft  like  Wetter- 
strand,  Moll,  Dubois,  and  others.  From  my  own 
experience  I  can  affirm  the  often  lasting  effect  in  the 
disturbances  of  the  functions  of  the  digestive  ap- 
paratus. The  stomach  and  the  intestines  seem  to  a 


3io  PSYCHOTHERAPY 

high  degree  under  nervous  influences  which  can  be 
changed  through  hypnotic  suggestion.  If  we  con- 
sider what  intimate  connection  exists  between  the 
functions  of  these  organs  and  the  normal  emotions,  it 
seems  hardly  surprising  that  mental  factors  can 
regulate  their  disturbances.  Vomiting,  diarrhea, 
and  especially  constipation,  often  yield  to  slight  sug- 
gestions, even  in  a  superficial  hypnotic  state.  Here, 
too,  I  have  seen  repeatedly  a  complete  regulation  of 
a  long-standing  disturbance  as  an  unintended  by- 
product of  hypnotic  suggestion  directed  towards  the 
cure  of  psychical  troubles.  Much  value  is  claimed 
for  hypnotic  method  in  the  treatment  of  anaemic  con- 
ditions. It  is  said  that  anaemia  improves  after  a  few 
hypnotic  treatments,  the  appetite  becomes  better,  the 
cold  hands  and  feet  grow  warmer,  the  headaches  dis- 
appear, the  capacity  for  work  increases  rapidly,  and 
most  surprising  of  all  the  leucorrhea  ceases.  As  to 
heart  disease,  we  ought  to  think  in  the  first  place  of 
the  disturbances  of  nervous  innervation.  I  have  seen 
repeatedly  a  remarkable  decrease  of  nervous  palpita- 
tion of  the  heart  through  direct  mental  influence,  ab- 
stracting here  from  the  secondary  effect  of  suppress- 
ing mental  excitement  and  fear.  Where  organic 
heart  diseases  are  surely  present,  it  seems  that  hypno- 
tism can  sometimes  act  beneficially  if  the  heart 
trouble  is  accompanied  by  anaemia  and  general  de- 
bility ;  of  course  a  developed  valvular  disease  cannot  be 
removed.  In  the  same  way  it  seems  that  in  B right's 
disease,  certain  painful  symptoms  may  be  suppressed, 
but  the  kidneys  certainly  cannot  be  influenced.  At 


THE  BODILY  SYMPTOMS          311 

least  open  to  serious  suspicion  are  the  insistent  claims 
that  diabetes  can  be  cured  by  suggestion.  Dr.  Quack- 
enbos  of  New  York,  for  instance,  gives  to  some  of 
his  diabetes  patients  a  hypnotic  suggestion  by  the  fol- 
lowing words :  "  If  your  pancreas  be  crippled  in  its 
production  of  the  natural  ferment  which  is  given  off 
to  blood  and  lymph  and  which  conditions  the  normal 
condition  of  sugar  in  the  body  or  restrains  the  out- 
put of  sugar  from  the  liver  tissues,  you  will  see  that  it 
forthwith  pours  into  your  blood  or  lymph  the  suf- 
ficient quantity  of  sugar  oxidizing  ferments."  It 
certainly  transcends  our  present  understanding  if  we 
are  to  believe  that  a  suggestion  of  this  type  will 
change  the  action  of  the  pancreas.  It  is  hardly  worth 
while  to  enter  into  the  still  more  extravagant  claims 
from  other  sides  like  those  for  curing  cancer  and 
phthisis.  On  the  other  hand,  in  the  light  of  all  that 
we  have  discussed,  there  is  no  difficulty  in  under- 
standing the  easily  observable  influence  in  the  regula- 
tion of  menstruation,  in  the  cure  of  contractions,  local 
congestions,  and  incontinency  of  urine.  I  may  men- 
tion finally  the  use  of  hypnotism  for  helping  in  a  safe 
and  quick  confinement. 

But  in  addition  to  all  this,  we  have  the  great  help 
which  psychotherapy  may  bring  indirectly  in  the 
treatment  of  physical  diseases.  I  said,  for  instance, 
that  I  do  not  believe  in  a  real  help  by  mere  suggestion 
in  cases  of  diabetes.  But  no  one  ought  to  under- 
estimate the  value  which  may  result  for  the  treatment 
from  a  suggestion  of  a  well-adapted  diet.  The  pa- 
tient who  feels  a  craving  for  bread  and  potatoes  and 


3i2  PSYCHOTHERAPY 

perhaps  sweets,  and  is  too  weak  to  resist  it,  is  indeed 
brought  into  safety  if  suggestion  liberates  him  from 
such  desires.  The  same  holds  true  for  every  other 
diet  and  for  any  medical  regime  of  life  which  does 
not  harmonize  with  the  natural  instincts  of  the  pa- 
tient. For  not  a  few  sufferers,  reenforcement  of  the 
interdict  against  coffee  and  tea  or  alcohol  and  tobac- 
co is  more  important  than  any  medicine.  Hypnotic 
suggestion  can  easily  create  dislike  of  the  prohibited 
material  and  can  build  up  new  desires  and  inclina- 
tions. In  the  same  way  it  is  indirectly  most  im- 
portant to  stir  up,  for  instance,  the  sensations  and 
feelings  of  appetite  and  thus  to  make  normal  nutri- 
tion possible.  Also  in  cases  of  anaemia  or  tuber- 
culosis, such  indirect  assistance  can  produce  some 
beneficial  consequences. 

The  same  holds  true  of  the  power  of  the  psycho- 
therapist to  secure  sleep.  The  fight  against  insomnia 
which  we  discussed  referred  only  to  that  sleeplessness 
which  is  itself  an  expression  of  the  disease.  But  as  a 
matter  of  course,  the  loss  of  sleep  can  accompany 
most  different  diseases,  as  an  almost  accidental  result. 
To  secure  sleep  means  then  not  to  treat  the  symptoms 
of  the  disease  but  a  by-product ;  and  yet  every  physi- 
cian knows  how  much  is  gained  if  the  lost  energies 
are  restituted  by  a  sound  sleep.  And  finally  we  have 
the  indirect  help  towards  the  cure  by  the  suggestive 
removal  of  pain.  We  have  no  right  to  say  that  it 
is  a  pure  advantage  for  the  treatment  of  the  disease 
if  the  pain  is  centrally  inhibited.  Pain  surely  has  its 


THE  BODILY  SYMPTOMS          313 

great  biological  significance  and  is  in  itself  to  a  certain 
degree  helpful  towards  the  cure,  inasmuch  as  it  indi- 
cates clearly  the  seat  and  character  of  the  trouble  and 
warns  against  the  misuse  of  the  damaged  organ  which 
needs  rest  and  protection.  To  annihilate  pain  may 
mean  to  remove  the  warning  signal  and  thus  to  in- 
crease the  chance  for  an  injury.  If  we  had  no  pain, 
our  body  would  be  much  more  rapidly  destroyed  in 
the  struggle  for  existence.  But  that  does  not  con- 
tradict the  other  fact  that  pain  is  exhausting  and  that 
the  fight  against  the  pain  decreases  the  resistance  of 
the  organism.  As  soon  as  the  disease  is  well 
recognized  through  the  medium  of  pain  and  the 
correct  treatment  is  inaugurated,  not  only  the  sub- 
jective comfort  of  the  patient  but  the  objective  in- 
terest of  his  cure  makes  a  removal  of  pain  most  de- 
sirable. While  it  would  be  absurd  to  say  that  hyp- 
notism can  cure  tuberculosis  or  cancer,  it  is  fully  just- 
ifiable to  say  that  hypnotic  treatment  in  tuberculosis 
or  cancer  is  to  a  high  degree  beneficial,  inasmuch  as  it 
can  secure  sleep,  appetite,  and  freedom  from  pain, 
three  factors  which  indirectly  help  to  fight  the  dis- 
ease. The  elimination  of  pain  may  sometimes  also 
play  its  role  in  slight  operations  where  other  methods 
of  narcosis  seem  for  any  reason  undesirable,  and  very 
frequently  hypnotic  suggestion  has  been  used  for  this 
purpose  at  childbirth. 

The  same  importance  which  belongs  to  the  re- 
moval of  bodily  pain  in  the  treatment  of  a  peripheral 
disease  may  be  given  to  its  mental  counterpart,  to  the 


PSYCHOTHERAPY, 

worry,  excitement,  and  emotional  shock.  They  all 
stand  in  the  way  of  a  real  success  in  any  cure.  Even 
the  chances  of  a  dangerous  operation  are  entirely  dif- 
ferent for  the  patient  who  goes  to  it  with  free  mind 
and  a  happy  mood,  with  full  confidence  in  its  success, 
from  those  of  a  patient  who  has  worked  himself  into 
a  state  of  fear  and  anxiety.  Here  again  the  de- 
pression and  the  excitement  are  not  in  question  as 
symptoms  of  a  disease,  as  they  were  when  we  dis- 
cussed the  phobias  and  despondencies  of  the  neu- 
rasthenic and  of  the  hysteric.  They  are  merely  nor- 
mal side-effects  of  the  bodily  disease,  accentuated  per- 
haps by  a  suggestible  temperament.  To  eliminate 
all  these  emotions  means  to  change  most  helpfully  the 
whole  atmosphere  of  the  sick-room  and  to  deprive 
invalidism  of  its  saddest  feature.  This  negative  fac- 
tor corresponds  of  course  most  directly  to  the  positive 
feature  of  building  up  new  hope  and  joyful  expecta- 
tion. He  who  creates  confidence  makes  con- 
valescence rapid  and  strengthens  the  power  to  over- 
come disease. 

It  would  be  medical  narrowness  if  the  physician 
were  strictly  to  deny  that  the  effect  of  such  emotional 
change  may  sometimes  lead  far  beyond  the  ordinary 
suggestive  influences  and  that  in  this  sense  the 
miraculous  really  happens.  When  out  of  a  despond- 
ent mood  in  a  suggestible  brain  an  absorbing  emo- 
tion of  confidence  breaks  through,  a  completely  new 
equilibrium  of  the  psychophysical  system  may  indeed 
result.  In  such  cases,  improvements  may  set  in 
which  no  sober  physician  can  determine  beforehand. 


THE  BODILY  SYMPTOMS          315 

Central  inhibitions  which  may  have  interfered  a  life 
long  with  the  normal  functioning  of  the  organism 
may  suddenly  be  broken  down  and  in  an  entirely  un- 
expected way  the  mental  influence  gives  to  the  forces 
of  the  body  a  new  chance  to  help  themselves.  The 
reasoning  of  the  scientific  physician  may  easily  stand 
in  the  way  there.  He  may  be  afraid  of  such  over- 
strong  emotion  because  he  knows  too  well  that  such 
unregulated  powers  may  just  as  well  destroy  the  good 
as  in  another  case  the  bad;  in  short,  that  ruin  may 
result  just  as  well  as  health.  But  that  does  not 
exclude  the  fact  that  indeed  almost  mysterious  cures 
can  be  made  without  really  contradicting  the  scien- 
tific theories.  Such  are  the  means  by  which  the  mys- 
•tical  cults  earn  their  laurels.  A  chance  letter  of  the 
type  which  often  swells  the  mail  of  the  psychologist 
may  illustrate  this  effect.  I  choose  it  because  it  is 
evidently  written  by  a  skeptic.  A  short  quotation 
'  from  the  lengthy  epistle  is  sufficient. 

"  My  condition  was  horrible  in  the  extreme.  I 
had  consumption  of  the  lungs  and  other  supposedly 
fatal  troubles,  complicated  by  wrecked  nerves.  At 
the  present  writing,  I  am  robust  and  splendidly 
healthy,  looking  twenty  years  younger  than  I  did  at 
the  period  previously  described.  The  Christian 
Scientist  saw  my  condition  but  appeared  unconcerned 
and  unafraid,  I  being  absolutely  hopeless,  skeptical, 
and  deeply  contemptuous  meanwhile.  On  the  third 
day  of  her  treatment  I  was  desperate  for  sleep,  she 
having  forbidden  drugs,  and  I  deliberately  took  an 
overdose  of  chloral,  thinking  to  die  at  once  and  end 


316  PSYCHOTHERAPY: 

it.  My  condition  justified  the  act.  She  brought  me 
out  of  the  coma  of  the  chloral  after  three  hours  of, 
mental  work,  and  the  next  day  I  felt  decidedly  calmer 
and  less  afraid  of  the  coming  of  night,  should  I  live 
to  meet  it,  which  seemed  doubtful.  At  noon  she  left 
me  to  go  to  her  home  to  lunch.  I  was  ponder- 
ing seriously  on  her  reiterated  '  God  is  love  and  fills 
the  universe  and  there  is  nothing  beside  Him,'  when 
I  suddenly  had  a  sensation  of  being  lifted  up  or  rising 
slowly  and  becoming  lighter  in  body.  A  rush  of 
power  that  I  have  no  way  of  describing  to  you  filled 
me.  I  seemed  to  be  a  tremendous  dynamo  in  the  air 
several  inches  above  the  ground  and  still  ascending. 
When  I  noticed  everything  around  me  becoming 
prismatic  and  more  or  less  translucent,  I  could  have 
walked  on  water  without  sinking,  and  I  had  distinct 
understanding  that  matters  seemed  to  be  disintegrat- 
ing and  dissolving  around  me.  I  was  frightened  but 
self-conscious  and  quiet.  I  remained  in  this  state  for 
about  three  hours,  my  consciousness  seeming  to  have 
reached  almost  cosmic  greatness.  I  could  have 
cured,  I  felt,  any  human  ill,  was  filled  with  an  ab- 
sorbing altruistic  desire  to  help  suffering.  It  was 
tremendous  and  totally  foreign  to  my  everyday  atti- 
tude. At  the  end  of  the  day,  towards  twilight,  I  be- 
came wearied  of  the  tremendous  throbbing  and  ex- 
alted state  in  which  I  still  remained  and  gave  utter- 
ance to  the  thought  aloud.  Almost  before  I  had 
formulated  it  the  condition  left  me,  and  like  the  sud- 
den dropping  of  a  weight,  I  struck  the  ground,  the 
same  dull,  ordinary  person  df  everyday  experience,  but 


THE  BODILY  SYMPTOMS          317 

with  the  vast  difference  of  perfect  health,  radiant  and 
lasting  to  the  present  writing.  My  father  like  myself 
is  baffled  and  wondering.  We  are  both  pretty  hard 
skeptics.  I  want  the  truth,  whether  it  be  terrible  or 
otherwise.  I  am  profoundly  grateful  to  the  Chris- 
tian Scientist,  if  I  regained  my  health  through  her 
ministrations,  but  I  have  not  so  far  been  able  to  label 
myself  and  rise  in  their  church  services  to  tell  what 
has  been  done  on  me.  The  performance  repels  me 
as  crude  and  rather  bad  taste.  I  swear  to  you  on  my 
honor  as  an  American  woman  and  a  mother  that 
what  I  have  written  you  is  true,  absolutely.  If  you 
can  give  me  any  light  or  If  my  experience  may  per- 
chance give  you  a  helping  ray,  my  renewed  lease  on 
life  may  have  had  some  purpose  after  all,  which  I 
have  often  questioned  in  my  cynical  moods." 

The  unprejudiced  psychotherapist  will  be  perfectly 
able  to  find  room  for  such  cures  and,  if  it  is  the  duty 
of  the  scientific  physician  to  make  use  of  every  natural 
energy  in  the  interest  of  the  patient's  health,  he  has 
no  right  to  neglect  the  overwhelming  powers  of  the 
apparently  mysterious  states.  Some  of  this  power 
ought  to  irradiate  from  his  eye  and  his  voice  whenever 
he  crosses  the  threshold  of  a  sickroom.  Some  of 
that  power  ought  to  emanate  from  him  with  every 
pill  and  drug  which  he  prescribes.  The  psychothera-"" 
peutic  energies  which  work  for  real  health  outside  of 
the  medical  profession  form  a  stream  of  vast  power, 
but  without  solid  bed  and  without  dam.  That  stream 
when  it  overfloods  will  devastate  its  borders  and 
destroy  its  bridges.  The  physicians  are  the  engi- 


3i8  PSYCHOTHERAPY 

X    neers  whose  duty  it  is  to  direct  that  stream  into  safe 
\  channels,  to  distribute  it  so  that  it  may  work  under 
\  control  wherever  it  is  needed,  and  to  take  care  that  its 
-powerful  energy  is  not  lost  for  suffering  mankind. 


PART  III 
THE  PLACE  OF  PSYCHOTHERAPY 

XII 
PSYCHOTHERAPY  AND  THE  CHURCH 

THE  belief  in  supernatural  energies  has 
cured  diseases  at  all  times  and  among 
all  peoples.  Everywhere  the  patient 
sought  help  through  the  agents  of  higher  forces 
and  everywhere  these  agents  themselves  utilized 
their  therapeutic  success  for  strengthening  the 
belief  in  their  over-natural  power.  The  psychol- 
ogist would  say  that  it  was  always  the  same  story, 
the  influence  of  suggestion  on  the  imagination  of 
those  who  suffer.  Yet  the  variety  of  forms  is 
abundant.  Not  only  the  special  symbols  but  the 
whole  attitude  may  take  most  varied  character,  and 
every  special  appearance  is  intimately  related  to  the 
whole  mystical  background  and  to  the  religious,  scien- 
tific, and  social  ideas  of  the  time.  If  nevertheless, 
even  at  the  same  time  in  the  same  country,  very  dif- 
ferent forms  of  religious  suggestion  are  at  work,  it 
must  not  be  forgotten  that  those  who  live  together 
in  any  nation  and  are  united  in  many  common  pur- 

319 


320  PSYCHOTHERAPY 

poses  represent  after  all  different  stages  in  the  de- 
velopment of  civilization.  It  has  always  been  true 
that  those  whose  minds  are  saturated  with  the  real 
culture  of  their  time  are  working  together  with  those 
whose  culture  belongs  to  earlier  centuries  and  with 
others  whose  minds  are  essentially  of  the  type  of  the 
primitive  peoples. 

Let  us  glance  at  the  life  of  the  savages.  In  dark- 
est Africa,  we  find  a  special  caste  with  its  professional 
secrets  which  accepts  new  members  only  after  long 
tests.  They  are  evidently  persons  with  over-sensitive 
nervous  systems  and  liable  to  hallucinations.  As 
soon  as  they  have  their  attacks  of  abnormal  excite- 
ment, they  are  conceived  to  be  agents  of  superhuman 
powers,  and  on  account  of  this  they  are  able  to  pre- 
scribe the  cure  of  any  diseases.  In  Australia,  thera- 
peutic power  belongs  to  the  koonkie,  a  man  who  as 
a  child  had  a  vision  of  a  demonic  god.  From  him 
he  received  the  power  to  heal  the  sick.  He  goes  to 
the  patient,  touches  the  painful  parts  and  rubs  them 
and  after  a  few  minutes,  he  shows  a  little  piece  of 
wood  which  he  had  hidden  in  his  hand  and  which  he 
claims  to  have  extracted  from  the  body  of  the  sufferer. 
The  native  feels  actually  cured  after  such  manipula- 
tion of  the  koonkie,  who  evidently  believes  himself  in 
his  power.  In  Siberia,  we  find  shamanism.  The 
shaman  stands  between  man  and  the  gods.  These 
shamans  are  excitable  persons  with  epileptic  tend- 
encies, or  at  least  over-suggestible  men  or  women  who 
by  autosuggestion  and  imitation  can  bring  them- 
selves into  ecstatic  convulsions.  They  alone  know 


AND  THE  CHURCH  321 

from  the  gods  the  means  to  treat  diseases  and  their 
personal  influence  overcomes  the  ailment.  In  early 
America,  before  the  European  discovery,  the  cure  of 
disease  belonged  in  the  same  way  to  the  middleman 
between  the  gods  and  human  beings.  In  the  An- 
tilles, for  instance,  the  bohuti  heals  the  diseases  which 
are  regarded  as  punishments  of  the  gods  for  human 
neglect.  The  priest  by  inhaling  a  certain  powder 
brings  himself  into  an  ecstatic  condition,  then  presses 
the  painful  organs  of  the  patient,  sucks  at  various 
parts  of  his  body  until  he  finally  produces  some  little 
bone  or  piece  of  meat  which  until  then  he  kept  hidden 
in  his  mouth.  The  disease  disappears,  and  the  ex- 
tracted bone  is  used  as  an  amulet  which  secures  good 
harvests.  Other  Indians  had  their  piachas.  They 
were  selected  from  among  the  boys  of  about  ten  years 
old  and  were  then  sent  to  lonely  forests  where  they 
had  to  live  for  years  upon  plants  and  water  without 
any  friends,  seeing  only  at  night  the  older  priests 
from  whom  they  learned  the  ceremonies  for  curing 
the  sick.  Here  too  their  art  consisted  mostly  in 
touching  the  painful  parts  of  the  body  with  the  lips 
and  sucking  them  to  bring  the  evil  saps  out  of  the 
body  by  their  supernatural  power.  In  short,  at  the 
most  primitive  stages  in  Africa  and  Asia,  in  America 
and  Australia,  therapy  was  acknowledged  to  be  a 
special  power  of  men  who  had  superhuman  forces 
derived  from  good  or  evil  gods. 

All  this  repeats  itself  in  the  so-called  half-civiliza- 
tions. Among  the  masses  of  China,  mental  and 
bodily  diseases  were  ascribed  to  the  fox,  which  plays 


322  PSYCHOTHERAPY; 

such  a  large  part  in  the  superstitions  of  eastern  Asia. 
The  priest  has  the  power  to  banish  the  fox  by  mys- 
tical writings  which  he  pastes  on  the  wall  of  the  sick- 
room, and  the  patient  recovers,  as  the  fox  has  to  leave 
his  body.  In  old  Japan  the  mountain  monks,  who 
inherited  their  superhuman  powers  from  a  martyr  of 
the  fifth  century,  can  remove  the  diseases  which  have 
magical  origin  or  which  are  induced  by  the  devil. 
They  also  supply  the  magical  papers  covered  with 
writings  and  pictures  of  birds,  to  prevent  the  ap- 
pearance of  smallpox  and  pestilence  and  to  cure  a 
number  of  diseases.  India,  the  classical  land  of  sug- 
gestion and  hypnosis,  shows  the  most  extensive  con- 
nection between  religious  and  magical  powers  among 
which  the  cure  of  diseases  is  only  one  feature.  Such 
cure  may  be  with  medicaments  or  without,  but  the  es- 
sential part  always  belongs  to  the  prayers  which 
make  the  good  and  evil  spirits  obedient  to  the  healer. 
These  prayers  were  often  spoken  in  Sanscrit,  which 
the  people  did  not  understand  and  which  thus  added 
to  the  mystic  solemnity  of  the  procedure.  This  sug- 
gestive influence  of  the  use  of  older  languages  for 
religious  solemnities,  known  only  to  the  priests,  re- 
peats itself  also  at  all  times  and  among  all  nations. 
In  Assyria  and  Babylonia,  too,  medicine  was  exclu- 
sively a  branch  of  mysticism  and  essentially  in  the 
hands  of  the  priests,  who  by  words  and  magical 
beverages  annihilated  the  influence  of  the  malevolent 
demons.  It  is  well  known  how  the  Old  Testament 
reports  the  same  traits  of  belief  among  the  Jewish 
nation.  We  hear  there  that  Miriam  became  leprous, 


AND  THE  CHURCH  323 

white  as  snow,  and  Moses  cried  unto  the  Lord,  say- 
ing :  "  Heal  her  now,  oh  God,  I  beseech  thee." 
And  after  seven  days  Miriam  was  cured  in  conse- 
quence of  Moses'  prayer.  And  again,  "  The  Lord 
sent  fiery  serpents  among  the  people  and  they  bit 
the  people  and  much  people  of  Israel  died. — And 
Moses  prayed  for  the  people. — And  Moses  made  a 
serpent  of  brass  and  put  it  upon  a  pole  and  it 
came  to  pass  that  if  a  serpent  had  bitten  any 
man,  when  he  beheld  the  serpent  of  brass,  hs 
lived." 

Among  the  old  Egyptians,  it  was  especially  Isis 
who  discovered  many  remedies  and  had  been  much 
experienced  in  medicine,  and  after  having  become  im- 
mortal, it  was  her  greatest  pleasure  to  cure  the  sick 
and  to  announce  the  right  remedies  in  dreams  to 
those  who  came  to  sleep  in  her  temples.  Many  who 
could  not  be  cured  by  any  physician,  and  who  had 
lost  their  sight  and  hearing  or  could  not  move  their 
limbs,  became  well  again  when  they  took  refuge  in 
her  temples.  The  same  holds  true  for  the  Serapis 
temple;  even  the  best  known  men  go  there  to  sleep 
to  get  from  the  goddess  cures  for  themselves  or  for 
their  friends.  It  is  well  known  again  that  in  other 
ways  the  old  Greeks  attached  medical  influence  to 
temples  and  sacred  springs  and  rivers  and  tombs. 
There  were  sacred  springs  which  cured  everybody 
who  drank  from  them,  there  were  statues  which  re- 
moved every  disease  when  offerings  were  brought  to 
them.  Here  again  the  most  frequent  is  the  cure  of 
paralytic  symptoms  and  of  obsessions.  The  Orphic 


324  PSYCHOTHERAPY 

priests   of  old  Greece   most  nearly   resembled  the 
shamans  of  the  savages. 

Those  who  are  inclined  to  give  to  the  life  of  Christ 
a  rationalistic  interpretation  have  often  pointed  out 
that  the  therapeutic  effects  described  in  the  Gospels 
might  also  be  understood  as  effects  of  suggestion  by 
word  and  tactual  impressions,  produced  especially  on 
hysterics,  epileptics,  paralytics,  and  psychasthenics. 
Such  rationalistic  interpretations  could  also  explain  in 
the  same  way  through  the  suggestive  influence  in  the 
minds  of  the  sick,  those  cures  which  Christ  effected 
through  others  without  being  present  himself.  Here 
belongs  perhaps  the  cure  of  the  servant  of  the  cen- 
turion in  Capernaum  or  the  cure  of  the  daughter  of 
the  woman  of  Canaan.  "  And  when  he  had  called 
unto  him  his  twelve  disciples,  he  gave  them  power 
against  unclean  spirits  to  cast  them  out  and  to  heal 
all  manner  of  sickness  and  all  manner  of  disease." 
The  Acts  give  us  the  full  details  of  how  Peter  and 
Paul  cured  the  lame  and  how  special  miracles  were 
performed  by  their  hands.  No  doubt  this  belief  in 
the  curative  effect  of  the  disciples  and  their  successors 
fills  the  first  centuries  after  Christ.  Eusebius  tells  us 
how  they  healed  the  sick  by  laying  on  of  hands.  The 
forms  were  frequently  changing  through  the  history 
of  Christianity  but  the  essence  remains  the  same. 
Sometimes  more  emphasis  is  laid  on  the  personal  fac- 
tor of  the  priest,  sometimes  more  on  the  sacred  origin 
of  the  symbol  as  in  the  case  of  the  relies,  sometimes 
more  on  prayer  and  godly  works,  but  it  is  always  the 
religious  belief  which  cures.  Typical  are  the  thera- 


AND  THE  CHURCH  325 

peutic  wonders  of  Francis  de  Assisi.  He  banishes 
devils,  cures  gout,  lameness,  and  blindness.  The 
traditional  means  of  suggestion,  prayer  and  the  lay- 
ing on  of  hands,  had  in  the  meantime  been  supple- 
mented by  the  sign  of  the  cross  which  the  church  had 
added.  Moreover  whatever  he  had  only  touched 
became  a  remedy  for  the  sick.  Protestantism 
brought  no  change  in  this  respect.  Martin  Luther 
writes:  "  The  physicians  consider  in  the  diseases  only 
the  natural  causes  from  which  a  disease  results  and 
want  to  remove  them  by  their  medicines,  and  they 
are  quite  right  in  it.  But  they  do  not  see  that  the 
devil  often  sends  to  one  a  disease  which  has  no 
natural  causes.  Therefore  there  must  exist  a  higher 
medicine,  namely,  the  religious  belief  and  the  prayer 
through  which  the  spiritual  medicine  can  be  found  in 
the  word  of  God." 

The  broad  undercurrent  of  religious  cures,  es- 
pecially in  the  Catholic  Church  and  in  the  Greek 
Church,  but  with  fewer  symbols  also  outside  of  them, 
has  up  to  the  present  time  never  ceased  to  flow.  But 
independent  of  it  the  therapeutic  belief  has  again  and 
again  been  focused  on  certain  individuals  or  certain 
sects  or  certain  schools,  in  the  midst  of  the  steady 
progress  of  scientific  medicine  and  sometimes  synthe- 
sizing the  religious  claims  with  new-fashioned  schol- 
arly ideas.  In  the  seventeenth  century,  for  instance, 
the  Irish  nobleman  Greatrakes  became  a  famous 
center  of  attraction.  He  felt  himself  to  be  the 
bearer  of  a  divine  mission  and  healed  the  sick,  appeal- 
ing to  their  belief  by  laying  on  of  hands  and  by  move- 


3a6  PSYCHOTHERAPY 

ments  which  we  nowadays  call  passes.  Much  more 
influential  in  the  eighteenth  century  was  Pastor  Gass- 
ner  in  Germany.  Gassner  succeeded  in  producing 
with  his  religious  psychotherapy  such  a  tremendous 
stir  that  many  thousands  who  needed  cure  from 
functional  diseases,  and  thousands  of  curious  people, 
too,  streamed  to  his  church  in  Ellwangen,  and  his 
methods  of  cure  spread  almost  contagiously  among 
the  ministers  of  the  country:  an  Emmanuel  Church 
Movement  of  the  eighteenth  century.  Gassner,  too, 
'discriminated  between  the  diseases  which  have  natural 
causes,  that  is  the  organic  diseases,  which  he  did  not 
treat,  and  the  functional  ones,  which  were  obsessions 
of  the  devil.  To  determine  to  which  group  the  dis- 
ease belonged,  he  ordered  the  devil  to  produce  the 
symptoms  of  the  sickness.  When  in  this  way  the  ob- 
sessional character  of  the  disease  was  recognized,  the 
minister  began  with  his  suggestive  influences  to  ban- 
ish the  devil.  He  demanded  firm  confidence  in  the 
name  of  Christ,  reenforced  his  effectiveness  by  nar- 
ration of  the  cures  he  had  perfected,  used  further 
certain  manipulations  such  as  the  rubbing  of  the  skin 
and  passes  on  the  head,  and  finally  gave  his  sug- 
gestions with  authoritative  firmness.  Many  ministers 
who  became  his  pupils  treated  like  him  with  skillful 
combination  of  religion  and  hypnoid  influences  the 
spasms,  catalepsies,  neurasthenias,  paralysis,  and 
deafness,  of  neurotic  patients. 

There  is  no  need  to  follow  in  detail  the  frequent 
similar  occurrences  between  Gassner's  time  and  our 
own.  We  all  know  where  we  are  to-day.  The 


AND  THE  CHURCH  327 

medical  profession  and  the  medical  science  with  its 
bacteriology  and  serum  therapy,  its  Roentgen  rays 
and  its  organic  chemistry  is  far  away  from  the  church 
and  without  concession  to  religious  aspects.  On  the 
other  hand  there  are  the  yearly  processions  of  thou- 
sands and  thousands  who  make  their  pilgrimage  to 
the  sacred  waters  of  Lourdes,  guided  by  the  Catholic 
priests,  half-hypnotized  by  the  hope  that  the  Virgin 
will  cure  them.  In  every  niche  of  the  Catholic 
churches  in  all  Europe,  there  are  kneeling  before  the 
burning  candles  those  who  pray  for  nothing  but  their 
health;  and  their  belief  will  sometimes  yield  almost 
miraculous  cures.  In  England  the  Society  of  Em- 
manuel was  founded  by  men  and  women  to  whom  it 
seemed  necessary  to  bring  back  to  the  minds  of  Chris- 
tians the  undoubted  fact  that  Christ  taught  and 
worked  for  physical  heath  and  to  revive  this  sense 
of  power  over  disease.  Thousands  were  treated  and 
the  results  have  been  "  most  encouraging."  Among 
the  cases  successfully  treated  may  be  mentioned  "  one 
of  cancer  in  which  case  the  specialist  called  in  had 
given  the  sufferer  only  three  months  to  live  while 
by  means  of  the  laying  on  of  hands  in  prayer,  a  com- 
plete cure  was  effected." 

Not  dissimilar  in  its  proceedings,  though  much 
more  elaborate  in  its  metaphysics  than  this  movement 
in  the  midst  of  the  Church  of  England,  we  find  in 
America  the  Christian  Science  movement  started  by 
Mrs.  Eddy.  It  was  new  as  a  therapeutic  system, 
however  old  its  philosophic  elements.  Mrs.  Mary 
Baker  Eddy  writes:  "  In  the  year  1866  I  discovered 


328  PSYCHOTHERAPY 

the  Christ  science  or  divine  laws  of  life  and  named 
them  Christian  Science.  God  had  been  graciously 
fitting  me  during  many  years  for  the  reception  of  a 
final  revelation  of  the  absolute  divine  principle  of 
scientific  being  and  healing."  The  disease  is  cured 
for  the  Christian  Scientist  by  the  belief  in  God  be- 
cause a  true  belief  in  God  includes  the  insight  that 
God  is  all  reality  and  that  reality  therefore  cannot 
include  the  ungodlike,  that  is,  error  and  sin  and  dis- 
ease. Disease  is  thus  recognized  as  unreal  and  if  it 
has  become  unreal,  of  course  it  has  disappeared  as 
part  of  our  real  life.  Thousands  and  thousands 
have  been  cured  under  this  symbol.  And  as  the 
latest  chapter  of  this  history  of  five  thousand  years, 
we  find  the  movement  which  Dr.  Worcester  has 
started  in  Boston  and  which,  too,  spreads  rapidly  over 
the  continent  and  awakens  the  ambition  of  many  a 
minister  in  every  denomination  in  the  land.  The 
aim  is  to  cure  the  patient  by  reenforcing  in  him 
through  religious  persuasion,  through  the  contact 
with  the  symbols  of  the  church  and  with  godly  men 
and  through  religious  suggestion,  a  confident  belief 
which  gives  new  unity  and  through  it  new  strength  to 
the  mind  of  the  sufferer  until  it  overcomes  the  func- 
tional disease  of  the  body.  The  physician  at  first 
examines  whether  or  not  an  irreparable  organic  dis- 
ease has  attacked  the  body,  but  if  he  does  not  find 
such  organic  destruction,  then  the  patient  is  to  be 
handed  over  to  the  minister,  who  will  take  care  that 
through  his  religious  belief  and  inspiration  the  mind 
will  triumph  over  the  weakness  of  the  body. 


AND  THE  CHURCH  329 

Whoever  looks  in  this  way  over  the  history  of 
mankind  can  no  longer  doubt  that  belief  in  super- 
natural powers  is  really  an  agency  for  the  over- 
coming of  disease.  We  may  be  interested  in  it  from 
the  standpoint  of  religion  or  from  the  standpoint  of 
psychology  or  from  the  standpoint  of  ethnology.  In 
every  case  we  have  to  acknowledge  that  he  who  be- 
lieves may  be  cured.  If  we  abstract  first  from  the 
religious  point  of  view  and  consider  the  problem  as 
a  scientific  one,  we  have  to  interpret  all  those  cura- 
tive effects  of  belief  as  results  of  suggestion.  The  at- 
titude of  the  one  who  gives  the  suggestion  has  gone 
in  the  history  of  mankind  through  all  possible  varia- 
tions. He  may  have  been  filled  with  fervent  belief, 
rejecting  any  interpretation  except  the  religious  one, 
or  he  may  have  produced  the  suggestion  of  belief 
almost  with  the  intentions  of  a  physician  who  simply 
relies  on  the  physiological  effects  of  any  suggestion; 
and  between  these  two  extremes  any  number  of  steps 
is  possible.  Moreover  the  suggestion  may  have  been 
detached  from  any  personality  and  may  have  be- 
longed to  any  symbol  of  religious  energies,  like  the 
relics  of  the  Catholic  Church.  Even  the  most  skep- 
tical of  ethnologists  ought  to  acknowledge  that  very 
little  in  this  history  of  religious  psychotherapy  points 
to  a  conscious  fraud.  Those  shamans  of  the  savages 
from  Siberia  to  South  Africa,  from  Australia  to 
Mexico,  are  in  ecstasies  which  make  them  really  be- 
lieve in  the  mysterious  power  of  their  manipulations. 
The  ethnologist  finds  indeed  as  most  common  char- 
acteristics of  all  those  primitive  movements  that  those 


330  PSYCHOTHERAPY 

who  cure  are  chosen  from  among  neurotics  who  by 
epileptic  attacks  or  hallucinations  and  obsessions  are 
predisposed  to  feel  themselves  as  bearers  of  a  higher 
mission. 

Yet  whether  the  attitude  of  the  transmitter  is  reli- 
gious or  half-scientific,  is  inspired  or  insincere,  the 
receiver  of  the  suggestion  is  always  in  the  same  con- 
dition :  he  is  believing  in  his  cure  through  religious  in- 
fluence and  through  his  belief  he  is  helped,  if  he  is 
helped  at  all.  This  uniformity  does  not  exclude  the 
fact  that  the  patients  too  may  show  a  manifoldness 
of  mental  states.  They  may  remain  in  a  completely 
waking  state  with  reenforced  suggestibility,  or  they 
may  go  over  into  a  drowsy  or  hypnoid  state  or  deeply 
into  a  hypnotic  state,  or  may  receive  the  suggestions 
as  we  saw  even  in  sleep.  Further  their  minds  may 
be  entirely  filled  with  fine  religious  emotions  and  the 
therapeutic  effect  be  only  an  appendix  or,  on  the  other 
hand,  this  confident  expectation  of  the  relief  from 
pain  may  be  their  central  content  of  consciousness  and 
may  control  the  whole  mental  interplay.  The  prac- 
tical problem  of  the  scientist  is  to  consider  how  far 
these  religious  energies  ought  to  be  used  today  in  the 
interests  of  the  cure  of  diseases. 

From  a  scientific  standpoint  such  a  discussion  can 
hardly  be  fruitful  with  those  who  consistently  take 
the  religious  point  of  view  only.  A  view  of  the 
world  which  demands  the  faith  that  religious  belief 
moves  an  almighty  power  to  cure  a  diseased  organ,  or 
that  the  disease  has  no  reality  for  one  who  lives  in 
God,  is  invulnerable  to  merely  scientific  arguments. 


AND  THE  CHURCH  331 

The  sick  woman  who  kneels  between  the  candles  be- 
fore the  picture  of  the  Virgin,  praying  that  her  heart, 
which  the  physicians  declare  incurable  on  account  of 
a  valvular  disease,  be  cured,  moves  in  a  sphere  of 
thought  which  lies  entirely  outside  of  the  medical 
study  of  causes  and  effects.  The  same  holds  true, 
for  instance,  of  Christian  Science.  This  statement 
is  in  itself  no  criticism  and  no  argument;  it  only  ac- 
knowledges that  any  possible  exchange  of  opinions 
has  to  be  carried  over  from  the  scientific  psycho- 
logical ground  to  that  of  metaphysics  and  philosophy. 
It  is  quite  different  with  modern  movements  of  the 
type  of  the  Emmanuel  Church  Movement,  where  the 
religious  thought  is  intertwined  with  the  psychological 
theory  and  where  an  actual  cooperation  of  physician 
and  minister  is  sought.  Here  church  and  science 
really  meet  on  common  ground,  and  it  is  important 
to  examine  objectively  whether  it  is  wise  and  bene- 
ficial to  encourage  the  spreading  of  this  tempting 
enterprise.  The  movement  has  reached  the  large 
cities  between  the  Atlantic  and  the  Pacific  and  is 
beginning  to  captivate  the  ministers  of  the  small 
towns  and  villages.  It  seems  as  if  an  epoch  has 
come  for  the  church — the  church  which  too  long  has 
ministered  only  to  the  spiritual  needs  of  the  com- 
munity will  at  last  remember  again  that  Christ  healed 
the  sick,  that  mind  and  body  are  one,  that  the  person- 
ality must  be  understood  in  its  unity,  and  that  endless 
fields  of  blessed  influence  may  again  be  opened  to  the 
church  when  the  minister  becomes  the  physician  of 
his  congregation.  Whoever  knows  the  suggestive 


332  PSYCHOTHERAPY 

power  of  such  a  social  movement,  and  considers  the 
ease  with  which  triumphant  successes  may  be  reached 
in  this  field  and  the  disappointing  and  discouraging 
reduction  of  power  which  the  church  shows  every- 
where in  its  purely  spiritual  hold  on  the  commu- 
nity, can  foresee  that  all  the  conditions  are  favor- 
able for  a  rapid  spread  and  that  the  church  clin- 
ics will  become  the  American  fashion  of  the  near 
future. 

It  cannot  be  denied  that  the  Christian  church  takes 
in  hand  there  once  more  a  work  which  belonged  to 
it  through  centuries.  But  they  were  centuries  in 
which  the  priest  was  in  a  certain  degree  the  physician, 
just  as  he  was  the  educator  and  teacher,  simply  be- 
cause in  the  church  there  was  centered  all  cultural 
influences  which  the  community  knew.  The  com- 
plexity of  modern  times  has  for  centuries  demanded 
the  opposite  system.  Centralization  is  allowed  only 
to  the  purely  administrative  influence  of  the  state, 
while  all  the  active  functions  are  divided  among  spe- 
cialists. We  rely  on  the  expert  in  education,  we  de- 
mand the  expert  in  medicine:  is  more  gained  or  lost 
if  the  religious  leader  now  again  suddenly  under- 
takes a  part  of  the  functions  which  belong  to  the 
physician?  It  is  true  that  the  ministers  of  this  school 
do  not  propose  to  undertake  the  physician's  work  to 
its  full  extent.  They  leave  to  him  the  first  and  in 
some  respects  most  important  step,  the  diagnosis,  and 
abstain  from  the  treatment  of  such  cases  as  the  physi- 
cian declares  inaccessible  to  psychical  influences. 
They  do  not  heal  cancer  and  phthisis  like  the  Em- 


AND  THE  CHURCH  333 

manuel  Movement  in  England  or  like  the  mental 
healers  in  America. 

But  is  not  perhaps  just  this  compromise  danger- 
ous in  another  direction,  inasmuch  as  it  awakens  a 
feeling  of  safety  in  those  who  feel  in  sympathy  with 
scientific  medicine?  They  have  passed  the  hand  of 
the  physician  and  believe  accordingly  that  because 
their  illness  is  recognized  as  functional,  the  minister 
can  really  perform  all  that  ought  to  be  done.  Is  this 
belief  justified?  At  the  threshold,  it  occurs  to  every 
one  that  such  a  diagnosis  by  physicians  may  be  er- 
roneous and  that  the  chances  for  such  error  are  under 
the  conditions  of  the  church  clinic  much  greater  than 
under  the  conditions  of  a  regular  medical  treatment. 
The  diagnostician  who  treats  the  patient  himself  has 
ever  new  chances  to  remodel  his  diagnosis  and  to 
correct  it  under  the  influence  of  therapeutic  effects. 
The  danger  is  great  that  under  the  proposed  con- 
ditions, the  activity  of  the  physician  will  be  super- 
ficial, because  he  is  deprived  of  his  chief  means,  the 
constant  observation.  But  we  may  abstract  from 
this  possibility  of  error.  Does  the  fact  that  the  dis- 
ease is  one  the  symptoms  of  which  may  yield  to  psy- 
chical treatment  really  make  it  advisable  that  the 
further  treatment  be  handed  over  to  the  clergyman? 
To  begin  at  the  beginning,  the  usefulness  of  psychical 
treatment  does  not  at  all  exclude  the  strong  desir- 
ability of  physical  treatment  at  the  same  time.  The 
emphasis  which  is  laid  on  religious  persuasion  and  in- 
spiration, on  prayer  and  spiritual  uplift  practically 
excludes  the  use  of  baths  and  douches,  of  massage 


334  PSYCHOTHERAPY 

and  electricity,  of  tonics  and  sedatives.  And  yet  it 
is  not  caprice  or  sham  when  every  well-schooled 
medical  specialist  applies  such  means  in  the  treatment 
of  these  so-called  functional  diseases  of  the  nervous 
system.  The  minister  applies  and  can  apply  only 
one  of  many  possible  methods  for  cure  and  yet,  if  we 
really  want  to  make  use  of  the  resources  of  modern 
knowledge,  we  have  to  adapt  most  carefully  all  pos- 
sible means  to  the  individual  case.  If  we  take  the 
strictly  religious  standpoint  the  situation  is  of  course 
different,  but  if  we  speak  of  psychophysiological  ef- 
fects, we  may  acknowledge  the  healing  influence  of 
prayer  and  yet  rely  in  the  special  case  still  more  on 
bromide  or  strychnine.  Yet  the  religious  psycho- 
therapists not  only  neglect  the  physical  help  but 
usually  emphasize  the  antagonism.  Some  of  the 
strongest  supporters  proclaim  it  as  a  non-drug  heal- 
ing, thus  deciding  adversely  about  a  medical  method 
regarding  which  they  have  no  means  at  all  to  judge. 

Parallel  to  this  neglect  of  physical  theory  goes,  of 
course,  the  neglect  of  the  physical  factors  in  the  dis- 
ease. The  physician  may  have  justly  diagnosed  that 
the  case  is  "  merely  "  neurasthenia  or  hysteria  and 
not  a  brain  tumor  or  paralysis  of  the  brain.  Yet  that 
does  not  mean  in  the  least  that  a  real  treatment  which 
remains  in  harmony  with  the  progress  of  modern 
medicine  ought  to  ignore  the  hundred  physical  ele- 
ments which  enter  daily  into  the  disease.  There  are 
the  most  complex  digestive  problems  involved  which 
demand  a  thorough  understanding  of  chemical  met- 
abolism, there  are  still  more  complex  problems  of  the 


AND  THE  CHURCH  335 

sexual  organs  which  the  minister  certainly  ought  not 
to  discuss  with  his  female  parishioners,  there  are 
bacteriological  questions,  there  are  questions  of  the 
peripheral  nervous  system  and  sense  organs ;  in  short, 
questions  which  belong  to  a  world  into  which  the 
minister  as  minister  has  nev^r  looked.  Even  if  he 
believes  he  might  gather  in  an  amateurish  way  some 
information  as  to  those  questions  which  lie  so  far 
from  his  experience  as  student  of  divinity,  how  can 
his  half-baked  knowledge  compare  with  the  experi- 
enced study  of  the  regular  physician?  Such  physical 
questions  cannot  be  settled  by  the  preparatory  ex- 
amination of  the  physician;  they  come  up  every  day 
during  the  treatment  and  what  the  spiritual  diet 
which  the  minister  offers  may  help,  may  at  the  same 
time  be  ruined  by  the  physical  diet  about  which  the 
minister  without  chemistry  cannot  judge. 

But  let  us  abstract  from  the  bodily  aspect.  Is  the 
situation  really  very  different  for  the  mental  one? 
The  appeal  to  the  religious  emotion,  the  reenforce- 
ment  of  religious  faith  is  from  the  religious  point  of 
view  certainly  the  one  central  effort  from  which 
everything  has  to  irradiate.  The  unity  of  this  con- 
trolling thought  is  the  glory  of  such  inspiration.  But 
as  soon  as  we  handle  this  thought  as  a  psychothera- 
peutic  remedy,  destined  to  restitute  the  disturbed  psy- 
chological equilibrium,  it  becomes  evident  that  the 
,very  uniformity  of  it  makes  it  a  clumsy,  inadjustable 
pattern.  If  there  is  anything  which  impresses  the 
careful  student  of  psychology,  it  is  the  over-rich  mani- 
foldness,  the  complexity  of  mental  life.  Even  the 


336  PSYCHOTHERAPY 

simplest  content  of  consciousness  is  a  tissue  woven 
from  millions  of  threads  and  any  stereotyped  influ- 
ence means  crudeness  and  destruction.  The  min- 
ister's attitude  towards  inner  life  is  there  directly 
opposite  to  that  of  the  psychologist.  He  cannot 
enter  into  those  endless  interplays/of  associations  and 
memories,  or  inhibitions  and  sensations  and  impulses, 
he  cannot  examine  from  which  remote  psychological 
sources  those  ideas  have  arisen,  how  the  feelings  be- 
come disturbed  and  the  judgments  sidetracked.  He 
should  not  analyze  even  if  he  could,  because  his 
whole  aim  is  to  synthesize.  He  asks  for  the  meaning 
and  not  for  the  structure,  for  the  aims  and  not  for 
the  elements.  His  therapeutic  effort  is  therefore  not 
even  directed  towards  a  careful  rebuilding  of  the 
injured  parts  of  the  mind,  but  it  is  nothing  more  than 
a  general  stimulation  to  the  mind  to  help  itself.  By 
touching  on  one  of  the  deepest  emotional  layers  of  the 
mind,  the  layer  of  religious  ideas,  the  minister  gives 
to  the  soul  an  intense  shock  and  expects  that  in  the 
resulting  perturbation,  everything  will  be  shaken  and 
may  then  settle  itself  by  its  own  energies  in  a  health- 
ful way.  It  is  a  fact  that  that  can  sometimes  happen 
and  under  certain  conditions  the  chances  for  it  are 
even  favorable.  Under  many  other  conditions  the 
chances  are  unfavorable  and  the  result  does  not  hap- 
pen at  all. 

But  whether  or  not  a  cure  results,  in  any  case  it  is 
certainly  not  an  effort  which  can  be  said  to  be  in  har- 
mony with  modern  science.  The  idea  of  science  is 
always  to  understand  the  complex  from  its  elements 


AND  THE  CHURCH  337 

and  to  restore  the  disturbed  complex  object  by  recog- 
nizing the  disturbances  in  the  elements  and  by  bring- 
ing those  disturbed  elements  into  right  shape  again. 
Certainly  the  psychologist,  too,  in  examining  care- 
fully the  injured  mental  mechanism  may  discover 
emotional  injuries  which  might  be  cured  by  the  in- 
troduction of  religious  ideas,  but  he  will  not  give 
to  them  a  value  different  from  the  introduction 
of  any  other  ideas  and  emotions,  for  instance, 
those  of  art  and  music  and  poetry,  those  of 
social  company  or  civic  interest,  of  travel  or  sport  or 
politics.  Each  may  have  its  particular  value  and  to 
cure  every  mind  with  religious  emotion  would  be  from 
a  psychological  point  of  view  as  onesided  as  it  would 
be  to  cure  every  disturbed  stomach  by  milk  alone. 
Moreover  in  very  frequent  cases,  for  instance,  of  neu- 
rasthenia or  hysteria  or  psychasthenia,  such  whole- 
sale remedies  can  form  only  the  background  of  the 
treatment,  but  all  the  details  have  to  be  furnished 
with  reference  to  a  most  subtle  analysis  of  the  special 
symptoms,  and  a  particular  organic  symptom  or  a 
particular  memory  idea  or  a  special  inhibition  by  a 
well-selected  counter-idea  will  do  much  more  than 
any  great  emotional  revival. 

Stereotyped  religious  appeal  is  not  only  insufficient 
in  an  abundance  of  cases — it  must  never  be  forgotten 
that  those  who  nowadays  go  to  the  minister  for  their 
health  are  already  selected  cases  more  open  to 
religious  suggestion  than  the  average — but  can  easily 
be  decidedly  harmful.  Of  course  that  holds  true  for 
every  physical  remedy  too,  and  the  judgment  of  the 


338  PSYCHOTHERAPY, 

exact  limit  is  one  of  the  chief  duties  of  the  physician. 
It  holds  also  for  the  other  mental  factors  like  sym- 
pathy. A  certain  amount  of  sympathy  may  save  a 
neurasthenic  from  despair,  and  only  a  little  more 
may  make  his  disease  much  worse  and  may  develop 
in  him  a  consciousness  of  misery  which  makes  him  a 
complete  invalid.  Still  more  is  it  true  for  the  reli- 
gious emotion,  from  the  standpoint  of  nervous  physi- 
ology the  strongest  next  to  the  sexual  emotion,  that 
it  can  be  the  healing  drug  or  the  destructive  poison. 
Everything  depends  upon  the  degree  of  the  intrusion 
and  upon  the  resistance  of  the  psychophysical  sys- 
tem. From  a  purposive  point  of  view  there  cannot 
be  faith  enough,  from  a  causal  point  of  view  there 
can  easily  be  too  much  of  the  faith  emotion.  Reli- 
gious fervor  has  at  all  times  helped  to  create  hysteria 
and  to  develop  psychasthenias.  It  cannot  be  other- 
wise. A  group  of  ideas  which  has  such  tremendous 
power  over  man  must  easily  be  able  to  produce  inhibi- 
tions and  exertions  which  become  dangerous  to  a 
nervous  system  the  constitution  of  which  is  patho- 
logical. To  leave  such  a  dangerous  and  powerful 
remedy  entirely  in  the  hands  of  men  who  by  their 
profession  must  aim  towards  a  maximum  dose  of  reli- 
gious influence  can  certainly  not  be  in  the  interests  of 
the  patients  or  of  the  community. 

Even  the  whole  technique  of  this  movement 
awakens  the  fear  of  possible  harmful  consequences. 
On  the  one  hand  we  have  the  movement  itself  as  a 
popular  suggestion  for  the  suggestible  masses.  The 
patient  who  seeks  the  help  of  a  scientific  neurologist 


AND  THE  CHURCH  339 

hardly  becomes  a  center  of  psychical  contagion,  but 
the  church  services  for  the  sick  offer  favorable 
conditions  for  an  epidemic  development  of  hysterical 
symptoms.  But  more  important  are  the  influences 
on  the  individual  patient.  The  whole  purpose  of  the 
treatment  demands  the  highest  possible  degree  of 
suggestibility  brought  about  by  the  ministerial  per- 
suasion. But  it  is  evident  that  this  degree  of  sug- 
gestibility means  at  the  same  time  the  most  fertile 
soil  for  every  chance  suggestion  and  for  influences 
which  are  perhaps  entirely  unintended.  The  physician 
and  the  psychologist,  considering  the  mental  state  with 
reference  to  its  elements,  will  make  most  careful  use 
of  those  accessory  influences.  The  minister,  who 
necessarily  has  his  spiritual  aim  in  mind,  cannot  even 
become  aware  of  all  the  involuntary  influences  which 
reach  the  mind  in  its  most  suggestible  state.  There 
can  be  no  doubt  that  it  would  often  need  psycho- 
logical art  to  avoid  the  creation  of  new  pathological 
symptoms  in  such  half-hypnotized  patients.  Yet  the 
minister  even  goes  so  far  as  to  make  use  of  the  sleep- 
ing mind  without  any  consideration  of  the  possible 
damage  which  may  be  done  to  his  subject.  He  goes 
to  the  bedside  of  a  sleeping  girl  and  whispers  his  sug- 
gestions and  is  satisfied  when  they  show  their  effects 
the  next  day.  It  does  not  lie  in  his  horizon  to  con- 
sider the  grave  consequences  which  such  suggestions 
during  sleep  may  produce  during  future  years  in  the 
brain  the  sleep  of  which  has  been  transformed  into 
such  half-somnambulic  relations.  Hysterias  may  be 
created  by  such  methods.  No  one  can  blame  the 


340  PSYCHOTHERAPY 

minister  for  his  remoteness  from  such  doubts  and 
problems,  but  the  physician  is  to  be  blamed  if  he 
encourages  the  belief  that  all  this  still  belongs  to  the 
proper  sphere  of  the  ministerial  worker  in  abnormal 
psychology. 

Those  engaged  in  such  work  were  not  long  in  find- 
ing out  that  the  mere  emotional  inspiration  is  often 
no  sufficient  remedy,  and  the  development  went  along 
the  same  lines  in  which  it  has  gone  everywhere  for 
some  thousands  of  years.  Not  to  disappoint  the  suf- 
ferers, the  religion  had  to  become  in  very  many  cases 
simply  an  inactive  side  issue  and  the  real  cure  was 
performed  by  the  same  methods  with  which  any 
worldly  neuropathologist  would  go  to  work.  If  the 
woman  who  cannot  sleep  is  cured  from  her  insomnia 
by  being  made  to  listen  to  the  beats  of  a  metronome, 
it  may  sometimes  be  effective,  however  crude,  but 
it  is  certainly  no  longer  religion,  even  though  the 
metronome  stands  in  a  minister's  room.  The  more 
the  movement  spreads  to  those  who  have  no  psy- 
chological training  and  knowledge,  the  more  it  must 
be  necessary  for  them  to  import  the  whole  clap- 
trap of  the  quack  hypnotist  and  soon  the  minister 
may  discover  that  in  certain  cases  physical  means  and 
drugs  help  still  better.  Thus  he  simply  enters 
into  competition  with  the  regular  physician,  only 
with  the  difference  that  he  has  never  studied  medi- 
cine. The  chances  are  great  that  in  his  hands 
even  such  remedies  and  drugs  may  do  harm  and 
finally,  even  if  they  were  effective,  is  not  the  question 
justified:  will  not  religion  suffer? 


AND  THE  CHURCH  341 

Indeed  we  have  so  far  considered  the  question 
from  one  side  only.  We  have  confined  ourselves  to 
the  question  of  how  far  such  a  movement  is  sound 
for  the  interests  of  the  patient;  but  can  we  be  blind 
to  the  other  side  and  overlook  the  not  less  important 
problem  of  whether  it  lies  in  the  interests  of  religion 
and  of  the  church  to  amalgamate  its  spiritual  work 
with  a  medical  one?  We  are  not  thinking  of  those 
widespread,  unfair  arguments  to  the  effect  that  this 
whole  movement  is  undignified  because  it  is  instituted 
by  the  desire  to  fill  the  empty  pews  or  to  make 
competition  with  the  success  of  Christian  Science. 
That  is  utterly  unjust.  But  there  are  intrinsic  fac- 
tors in  the  movement  which  interfere  with  the  true 
aims  of  religion.  First  of  all  it  cheapens  religion  by 
putting  the  accent  in  the  meaning  of  life  on  personal 
comfort  and  absence  of  pain.  The  originators  of 
the  Emmanuel  Movement  stand  well  above  such 
error,  but  their  national  congregations  do  not.  Cer- 
tainly the  longing  for  pleasure  and  a  well  feeling  and 
the  abhorrence  of  pain  and  illness  pervades  our  prac- 
tical life  and  keeps  in  motion  all  our  utilitarian  ef- 
forts. But  if  there  is  one  power  in  our  life  which 
ought  to  develop  in  us  a  conviction  that  pleasure  is 
not  the  highest  goal  and  that  pain  is  not  the  worst 
evil,  then  it  ought  to  be  philosophy  and  religion.  It 
is  only  the  surface  appearance  if  it  seems  as  if  the 
religious  therapeutics  minimizes  the  importance  of 
pain;  in  truth  it  does  the  opposite.  It  tries  to  abolish 
pain,  but  not  because  it  thinks  little  of  pain;  on  the 
contrary,  because  it  thinks  so  much  of  pain  that  it  is 


342  PSYCHOTHERAPY 

willing  even  to  put  the  whole  of  religion  into  the 
service  of  this  strife  for  bodily  comfort.  The  long- 
ing for  freedom  from  pain  becomes  the  one  aim  for 
which  we  are  to  be  religious.  In  a  time  which  denies 
all  absolute  ideals,  which  seeks  the  meaning  of  truth 
only  in  a  pragmatic  usefulness,  it  may  be  quite  con- 
sistent to  seek  the  meaning  of  religion  in  its  service 
for  removal  of  pain,  and  personal  enjoyment.  But 
in  that  case  the  ideal  of  both  religion  and  truth  is  lost. 
It  is  finally  not  less  undignified  for  religion  to  seek 
support  for  the  religious  belief  in  effects  which  it 
shares  and  knows  that  it  shares  with  any  superstitious 
belief  on  earth.  Granted  that  the  church  can  cure: 
the  shaman  of  Siberia  can  cure  too,  and  the  amulets 
of  Thibet  not  less.  The  psychologizing  church 
knows,  therefore,  that  it  is  not  the  value  of  the 
religion  which  restores  the  unbalanced  nervous 
system;  and  yet  it  wants  to  provide  for  the  spreading 
of  true  belief  by  the  miraculous  cures  which  it  ex- 
hibits. 

This  situation  naturally  produces  the  desire  of  the 
church  to  substitute  a  religious  explanation  for  a  psy- 
chological one.  It  is  claimed  that  after  all  it  is  not 
the  mental  effect  of  the  prayer,  but  the  prayer  itself, 
not  the  psychophysical  emotion  of  religion,  but  the 
value  of  religion  which  determines  the  cure.  Yet  in 
that  moment  the  whole  movement  in  its  modern 
shape  comes  into  a  still  more  precarious  position.  If 
the  cure  results  from  the  inner  value  of  the  religion 
how  can  we  confine  it  to  the  so-called  functional  dis- 
eases and  abstain  from  any  hope  in  organic  diseases  ? 


AND  THE  CHURCH  343 

Luther,  from  his  religious  point  of  view,  still  had  the 
right  to  separate  the  two  groups  because  only  those 
functional  diseases  were  effects  of  the  devil,  obses- 
sions which  could  be  banished  by  the  minister  and  by 
prayer,  while  the  other  diseases  did  not  result  from 
the  devil,  but  merely  from  natural  causes.  Such  a 
definition  does  not  fit  into  the  modern  system.  To- 
day from  a  really  religious  point  of  view,  both  groups 
of  diseases  must  be  acknowledged  to  be  natural  or 
with  Mrs.  Eddy,  as  the  work  of  the  unholy  spirit. 
Christian  Science  is  indeed  by  far  more  consistent. 
If  the  cure  results  through  the  meaning  and  value  of  I  » 
religion,  there  is  no  reason  whatever  why  cancer  and 
diphtheria  and  paralysis  should  not  be  cured  as  well  asJ 
psychasthenia.  And  if,  on  the  other  hand,  organic 
diseases  cannot  be  cured  because  the  psychophysical 
process  of  the  religious  emotion  has  no  influence  over 
diphtheria  bacilli,  then  the  whole  process  is  removed 
to  the  causal  sphere  and  it  is  acknowledged  that  the 
purposive  meaning  of  religion  is  not  in  question  at 
all.  The  whole  system  of  such  religious  psycho- 
therapeutics  is  therefore  in  its  inner  structure  con- 
tradictory. It  contains  causal  and  purposive  ele- 
ments without  any  possibility  of  unifying  them. 
They  are  loosely  mixed,  and  the  power  of  prayer 
means  on  one  page  something  entirely  different  from 
what  it  means  on  another.  In  these  respects  Chris- 
tian Science  is  by  far  more  unified  and  in  harmony 
with  itself;  its  therapeutics  is  really  anchored  in  a 
system. 

From  a  scientific  point  of  view,  its  dangerousness 


344 


PSYCHOTHERAPY, 


is  of  course  much  greater  Inasmuch  as  it  extends  its 
methods  over  every  organic  disease  and  thus  applies 
merely  psychical  treatment  where  from  a  standpoint 
of  scientific  medicine,  physical  treatment  would  be 
absolutely  necessary.  Moreover  its  philosophy  is 
after  all  only  a  pseudophilosophy ;  its  tempting  equa- 
tions of  disease  and  error  and  sin  and  unreality  are 
ultimately  a  mere  playing  with  conceptions.  If  we 
were  to  point  to  the  root  of  the  misunderstanding  in 
Christian  Science,  we  should  say  that  everything  de- 
pends on  the  philosophical  commonplace  that  the 
objects  with  which  we  deal  in  our  life  are  ideas  and 
that  our  whole  experience  is  mind.  "  Christian 
Science  reveals  incontrovertibly  that  Mind  is  All-in- 
All,  that  the  only  realities  are  the  divine  mind  and 
idea."  But  now  silently  this  mental  character  of  the 
real  world  is  identified  with  the  mental  experience 
which  stands  in  contrast  to  the  physical  experience. 
There  results  the  impression  that  physical  experience 
therefore,  does  not  belong  to  the  world  of  reality. 
It  is  evident,  however,  that  mental  in  contrast  to 
physical  means  something  entirely  different  from 
mental  in  the  philosophical  sense.  In  the  latter 
meaning  of  the  word,  we  all  agree  that  the  world  is 
,  mental;  the  word  mental  indicates  there  that  the 
world  has  reality  not  in  itself  but  only  as  experience 
of  subjects.  In  the  second  sense,  mental  or  psychical 
means  that  it  is  experience  for  one  particular  subject 
only  and  not  for  every  possible  subject.  The  phys- 
ical thing,  for  instance  this  table,  is  indeed  different 
from  my  mental  memory  idea  of  a  table,  inasmuch  as 


AND  THE  CHURCH  345 

every  possible  subject  can  experience  this  table  while 
my  mental  memory  image  belongs  to  me  alone.  The 
physical  table  and  the  mental  memory  image  of  it  are 
both  equally  mental  in  the  philosophical  sense,  inas- 
much as  the  physical  which  is  object  for  every  possible 
subject  and  in  this  sense  not  mental  is  therefore  not  less 
given  to  subjects.  Every  physical  body  with  its  dis- 
ease is  thus  in  one  sense  taken  as  something  not  mental 
while  in  another  sense  as  mental;  if  we  use  the  same 
word  in  two  entirely  different  meanings,  it  indeed 
cannot  be  difficult  to  demonstrate  any  metaphysical 
consequences. 

But  we  do  not  have  to  deal  here  with  the  meta- 
physics of  "  Science  and  Health."  If  it  is  brought 
down  to  the  concrete  application,  we  stand  before  the 
same  confusion  which  characterizes  all  compromises. 
Causal  effects  are  sought  in  a  sphere  which  belongs 
to  purposive  values.  The  psychological  effects  of 
the  emotion  of  faith  are  sought  and  are  misinter- 
preted as  the  emanations  of  religious  powers.  Reli- 
gious psychotherapeutics  in  all  its  forms  seeks  to 
demonstrate  to  us  the  triumph  of  the  soul  over  the 
body,  while  in  reality  it  deals  only  with  the  mental 
mechanism  which  as  such  belongs  to  the  chain  of 
causal  events  in  the  same  natural  way  as  the  organ- 
ism. The  soul,  as  spiritual  agency  in  its  sphere  of 
purposes  and  ideals,  does  not  enter  the  machinery  of 
psychotherapy,  and  the  psychological  material  on 
which  psychotherapy  is  applied  is  not  freer  and  not 
better  and  does  not  stand  higher  than  the  material  of 
the  bodily  cells  and  tissues.  The  Emmanuel  Move- 


346  PSYCHOTHERAPY 

ment  deserves  the  highest  credit  for  bringing  about  a 
systematic  contact  between  religious  faith  cure  and 
scientific  medicine,  but  the  time  in  which  the  minister 
himself  undertook  the  medical  treatment  had  to  be  a 
time  of  transition.  It  had  to  lead  to  a  new  relation 
in  which  the  ministerial  function  is  confined  to  the 
spiritual  task  of  upbuilding  a  mind  while  the  thera- 
peutic function  remains  entirely  in  the  hands  of  the 
physician.  Where  the  physician  believes  that  the 
psychomedical  treatment  demands  a  new  equilibrium 
of  the  patient  to  be  secured  by  religion,  there  the 
minister  should  be  called  for  assistance.  Psycho- 
therapeutic  hospitals  would  offer  the  most  favorable 
conditions  for  such  cooperation.  But  the  minister 
ought  to  enter  even  such  a  hospital  with  a  strictly 
spiritual  aim,  and  he  should  never  forget  that  the 
task  of  the  church  stands  much  higher  than  the 
utilitarian  task  of  removing  pain  from  the  sick  room. 
But  if  those  psychotherapeutic  hospitals  will  flourish 
and  the  physicians  will  at  last  make  use  of  psychical 
factors  in  their  regular  practice,  they  ought  not  to 
forget  on  their  part  that  the  important  step  forward 
was  taken  under  the  pressure  of  popular  religious 
movements.  The  ministers  first  saw  what  the  physi- 
cians ought  to  have  seen  before,  but  the  physicians 
will  see  it  more  fully  and  more  correctly. 


XIII 
PSYCHOTHERAPY  AND  THE  PHYSICIAN 

EVERY  thought  of  the  physician  moves  in  a 
world  the  structure  of  which  is  determined 
by  the  thought  forms  of  cause  and  effect. 
He  knows  the  effect  which  he  wants  to  produce;  it  is 
the  restitution  of  the  organic  equilibrium.  He  studies 
the  causes  which  can  secure  that  end.  And  again  the 
disturbance  of  the  equilibrium  itself,  the  disease,  is 
for  him  an  effect  which  he  seeks  to  understand  by  an 
analysis  of  the  preceding  causes.  The  means  which 
he  applies  can  therefore  be  valued  only  in  reference 
to  their  efficiency;  no  other  point  of  view  belongs  to 
his  world.  The  religiously  valuable  may  be  indiffer- 
ent or  even  undesirable  in  the  interplay  of  causes, 
and  the  morally  indifferent  may  be  most  important 
for  the  physician's  interests.  The  religious  emotion 
accordingly  has  to  stand  in  line  with  any  other  men- 
tal excitement  or  with  a  hundred  physical  means 
which  the  laboratory  and  the  drug  store  supply.  The 
physician  will  welcome  the  methods  of  treatment  with- 
out reference  to  metaphysical  systems  or  to  religious 
beliefs.  To  him  it  is  an  empirical  fact  that  many 
disturbances  of  mind  and  body  which  interfere  with 

347 


348  PSYCHOTHERAPY 

the  equilibrium  of  life  can  be  repaired  by  influences 
on  certain  psychophysical  organs.  A  part  of  these 
repairing  influences  he  finds  in  the  sense  stimuli,  for 
instance,  of  spoken  or  written  words  which  reach  the 
brain  and  awaken  associative  and  reactive  processes. 
He  finds  further  that  these  influences  can  be  reen« 
forced  in  their  effectiveness  by  certain  general  condi- 
tions of  the  nervous  system  and  again  finds  that  these 
can  be  secured  partly  by  sense  impressions,  and  once 
more  especially  by  words. 

It  is  a  matter  of  course  to  the  physician  that  appli- 
cation of  any  sense  influence  on  the  brain  demands  a 
most  subtle  analysis  of  the  psychophysical  situation. 
Therefore  he  gives  no  less  attention  to  the  disen- 
tangling of  the  whole  history  of  the  individual  brain, 
to  its  stored-up  energies  and  to  its  mental  possibili- 
ties. If  he  knows  the  psychophysical  status,  and 
finally  if  he  knows  the  means  of  influencing  those 
psychophysical  organs  which  stimulate  or  inhibit  the 
disturbed  central  parts,  he  can  foresee  the  psycho- 
physical  effects  with  a  certain  definiteness.  Thus 
everything  depends  upon  the  sharpest  possible,  almost 
microscopic,  mental  analysis,  together  with  a  most 
thorough  examination  of  the  whole  nervous  system 
and  the  most  careful  calculation  of  the  mental  in- 
fluences applied.  The  vagueness  of  the  religious  ap- 
peal transforms  itself  into  an  exact  calculation  and 
the  unity  of  the  soul  which  seeks  spiritual  uplift  trans- 
forms itself  into  a  mental  mechanism  of  bewildering 
complexity,  and  yet  not  more  complex  than  the  phys- 
ical organism,  to  which  for  instance,  the  chemical 


AND  THE  PHYSICIAN  349 

means  of  the  physician  administer.  Today  medical 
science  is  certainly  only  in  the  beginning  of  this  great 
movement.  Especially  the  analysis  of  the  psycho- 
physical  conditions  still  lacks  a  sufficient  refinement 
of  method.  But  at  least  the  causal  principle  is  now 
fully  recognized  and  the  scientific  man  of  today  no 
longer  doubts  that  this  whole  play  of  psychothera- 
peutic  processes  goes  on  as  a  causal  process  in  the 
psychophysical  system  of  the  individual  without  any 
mysteriousness,  without  any  magnetic  influences,  with- 
out any  miraculous  interference,  without  any  agen- 
cies except  those  which  are  working  in  our  ordinary 
mental  life  in  attention  and  reaction,  in  memory  and 
sleep. 

It  is  surprising  how  late  this  recognition  appeared 
in  the  history  of  human  knowledge.  It  occurred  here 
as  in  so  many  places  in  the  history  of  human  civiliza- 
tion that  the  simple  is  the  late  outcome  of  the  com- 
plex. Just  as  in  technique  the  apparatus  often  began 
in  a  complex,  cumbersome  way  and  then  became  stead- 
ily simplified,  so  it  is  with  explanations.  The  com- 
plex machinery  of  cosmic  influences  and  obsessions 
by  demons  and  magnetic  mysteries  was  at  first  neces- 
sary until  the  simple  explanation  was  found  that  all 
the  results  depend  upon  the  working  of  the  mind  it- 
self. Yet  in  technique  and  explanation  alike,  such 
progress  to  the  simpler  means  always  at  the  same  time 
the  making  use  of  much  richer  knowledge.  To  ex- 
plain an  obsession  or  a  sleep  state  by  the  agencies  of 
evil  spirits  or  magnetic  fluids  is  certainly  an  unneces- 
sary side  conception.  But  to  understand  it  from  the 


350  PSYCHOTHERAPY 

working  of  the  mind  presupposes  after  all  tRe  whole 
modern  physiological  psychology,  and  thus  had  to  be 
the  latest  step. 

The  effects  themselves  were  certainly  observed  in 
all  times.  Even  the  phenomena  of  hypnotism  date 
probably  back  some  thousands  of  years,  however  diffi- 
cult it  may  sometimes  be  to  discriminate  between  the 
artificial  hypnotic  states  and  hysteric  or  hystero-epi- 
leptic  occurrences  in  the  past.  Certainly  it  may  be  ac- 
knowledged that  the  Yogi  in  India  cultivated  in  the 
most  remote  times  the  methods  of  autosuggestion 
which  evidently  led  to  hypnotic  states,  and  everywhere 
around  the  Mediterranean,  antiquity  knew  the  hyp- 
notizing effect  of  staring  on  polished  metals  and  crys- 
tals. So  in  Egypt,  so  in  Greece  and  Rome;  and  it 
has  often  been  claimed  that  the  priestesses  of  Delphi 
and  the  sibyls  of  the  Romans  were  in  states  of  hystero- 
hypnotic  character.  As  to  the  therapeutic  use,  espe- 
cially the  Greek  physicians  applied  hypnotic  means. 
Excited  patients  were  brought  to  repose  by  methods 
of  stroking.  The  efforts  to  explain  scientifically  the 
mysterious  powers  which  men  can  gain  over  the  mind 
and  will  of  another  begin  at  the  end  of  the  Middle 
Age  and  were  developed  quite  naturally  from  the  pre- 
vailing astrological  doctrines.  Astrology  worked  on 
the  theory -that  the  human  fate  depends  upon  the 
stars.  These  stars  have  an  effect  on  the  human  or- 
ganism. That  proves  that  an  influence  can  exist  be- 
tween distant  bodies.  It  is,  therefore,  not  more  sur- 
prising that  one  organism  can  also  have  an  influence 
on  another  organism.  Well  known  since  antiquity 


AND  THE  PHYSICIAN  351 

were  such  influences  from  one  object  to  another,  as  in 
the  case  of  the  magnet.  Thus  there  may  be  a  kind 
of  magnetic  power  which  creates  relations  between  all 
objects  in  the  universe. 

Pomponnazi  explained  thus  at  the  end  of  the  fif- 
teenth century  the  therapeutic  effects  of  the  human 
soul  by  the  mutual  influence  which  stars  and  men  have 
on  each  other.  This  theory  comes  to  much  more 
important  development  in  the  writings  of  the  physi- 
cian Paracelsus.  One  individual  by  the  power  of  his 
effort  can  influence  the  will  of  another  individual,  can 
fight  with  it,  and  suppress  it;  and  all  through  ener- 
gies which  are  analogous  to  the  magnetic  power 
which  binds  stars  and  men.  In  the  middle  of  the 
seventeenth  century,  Helmont  connects  this  power  of 
magnetic  attraction  and  repulsion  with  an  ethereal  ele- 
ment which  penetrates  all  bodies  and  keeps  them  in 
motion.  Through  it  man,  too,  can  by  his  mere  imag- 
ination work  on  other  men.  This  will  can  also  be 
effective  on  drugs  which  get  through  it  a  special  thera- 
peutic power.  Somewhat  different  was  the  theory  o£ 
a  Scotch  physician,  Maxwell,  in  the  second  half  of  the 
seventeenth  century.  The  ethereal  spirit,  which  is 
identical  with  light,  can  be  artificially  cumulated  in 
any  organism  and  that  secures  its  health.  As  one 
man  can  influence  this  vivifying  ether  in  any  other 
man,  he  can  produce  cures  even  from  a  great  dis- 
tance. All  diseases  are  merely  reductions  of  this 
ethereal  spirit  in  the  organism. 

But  the  general  stream  of  the  explanation  con- 
tinued in  the  direction  of  the  magnetic  doctrine.  It 


352  PSYCHOTHERAPY 

was  especially  Mesmer  in  the  eighteenth  century  who, 
in  a  long  life  of  fantastic  mysticism  and  yet  of  uni- 
versal serious  study,  surely  contributed  much  to  the 
development  of  the  theory.  He  had  started  to  use, 
like  others,  the  magnet  in  his  medical  practice.  But 
he  discovered  that  the  same  therapeutic  successes 
could  be  gained  without  applying  the  magnet  itself, 
but  by  simply  using  his  own  hands.  The  patients  be- 
came cured  when  he  moved  his  hands  slowly  from 
their  heads  to  their  feet.  The  magnetic  power  was 
therefore  evidently  in  man  himself.  It  was  an  animal 
magnetism  in  opposition  to  the  mineral  one  which  be- 
longed to  the  magnet  and  to  the  stars.  He  believed 
further  that  he  was  able  to  infuse  this  magnetic  power 
into  any  lifeless  thing,  which  would  then  have  cura- 
tive influence  on  the  nerves.  There  can  be  no  doubt 
that,  whatever  may  have  been  the  value  of  his 
theories,  he  cured  a  large  number  of  patients,  evi- 
dently producing  a  state  which  we  would  call  today 
a  hypnoid  state  and  often  simply  appealing  to  the 
natural  suggestibility  of  the  impressionable  minds. 
Among  his  pupils,  usually  called  mesmerists,  was  Puy- 
seyur,  who  discovered,  in  1784,  the  state  which  was 
called  artificial  somnambulism,  a  kind  of  sleep  in 
which  the  ideas  and  feelings  of  the  magnetized  can 
be  guided  by  the  magnetizer.  Here  evidently  was 
the  first  recognition  of  the  psychotherapeutic  varia- 
tion which  we  call  today  hypnotism.  There  followed 
a  period  in  which  the  scientific  interest  of  the  physi- 
cians was  somewhat  sidetracked  by  an  unsound  con- 
nection of  these  studies  with  mystic  speculations  and 


AND  THE  PHYSICIAN  353 

with  clairvoyance.  But  especially  in  Germany  animal 
magnetism  in  Mesmer's  form  and  in  the  form  of  arti- 
ficial somnambulism  grew  in  influence  through  the 
first  decades  of  the  nineteenth  century  and  succeeded 
in  entering  the  medical  schools.  The  reaction  came 
through  popular  misuse.  At  about  the  third  decade 
of  the  century,  interest  ceased  everywhere. 

The  Portuguese  Faria  insisted  in  1819,  practically 
as  the  first,  that  all  those  so-called  magnetic  influ- 
ences, including  the  delusions,  the  amnesias  after 
awaking,  and  the  actions  at  a  command,  did  not  result 
from  a  magnetic  power  but  from  the  imagination  of 
the  subject  himself.  He  believed  that  the  effect  de- 
pended upon  a  disposition  of  the  individual  which  re- 
sulted from  a  special  thinness  of  blood.  He  ab- 
stained therefore  from  the  magnetic  manipulations 
and  produced  the  somnambulic  state  by  making  the 
patients  simply  fixate  his  hands  and  by  ordering  them 
to  sleep.  Thus  he  is  the  first  who  understood  these 
changes  as  results  of  mental  suggestion.  The  next 
great  step  was  due  to  the  English  surgeon,  Braid, 
who  in  the  forties  studied  the  magnetic  phenomena 
and  like  Faria  insisted  on  the  merely  mental  origin 
of  the  abnormal  state.  He  proved  that  a  person  can 
bring  himself  into  such  an  artificial  state  and  that  it  is 
therefore  entirely  independent  of  energies  from  with- 
out. He  examined  especially  the  influence  of  staring 
at  a  shining  object,  a  method  which  not  seldom  was 
called  Braidism.  He  also  introduced  the  word  hyp- 
notism. In  America  mesmerism  was  generally  known 
under  the  name  of  electrobiology;  and  Grimes  in  par- 


354  PSYCHOTHERAPY 

ticular  came  to  results  similar  to  those  of  Braid.  Yet 
the  influence  of  these  movements  on  the  medical 
world  remained  insignificant  until  a  new  great  wave 
of  psychotherapeutics  by  means  of  suggestion  began 
in  France  in  the  sixties. 

Of  course  this  development  from  astrology  to  mag- 
netism and  from  magnetism  to  hypnotism  represented 
only  one  side  of  psychotherapy.  Parallel  to  it  goes 
the  progress  in  :he  treatment  of  the  insane.  In  the 
first  half  of  the  eighteenth  century,  they  are  still  on 
the  whole  thrown  together  with  the  criminals  but  the 
more  the  disease  character  of  the  disturbance  is  ac- 
knowledged, and  the  more  special  hospitals  for  the 
insane  are  created,  and  finally  the  more  the  humane 
treatment  in  them  supersedes  the  brutal,  the  more 
psychotherapy  enters  into  the  work.  England  showed 
the  way.  Especially  Arnold,  Crichton,  and  Perfect 
became  influential;  and  soon  Pinel  and  Esquirol  fol- 
lowed in  France;  and  Reil  and  Langermann  in  Ger- 
many. Reil  recognized  clearly  at  the  threshold  of 
the  nineteenth  century  that  "  Both  psychical  and  phys- 
ical diseases  may  be  cured  by  psychical  means,  but 
at  the  same  time  psychical  diseases  may  also  be  cured 
by  physical  means."  And  in  his  "  Rhapsodies," 
rhapsodies  on  the  application  of  psychical  methods 
in  the  treatment  of  mental  disturbances,  he  declared, 
"  that  the  medical  Faculties  will  soon  be  obliged  to 
add  to  the  two  existing  medical  degrees  still  a  third, 
namely,  the  doctorate  in  psychotherapy."  This 
stream  became  broader  and  broader  and  every  new 
development  of  psychiatry  in  the  last  hundred  years 


AND  THE  PHYSICIAN  355 

did  new  justice  to  the  influence  of  psychological  means 
in  the  treatment  of  mental  diseases;  to  be  sure,  with- 
out allowing  up  to  the  present  day  the  hope  that  men- 
tal factors  as  such  can  cure  the  grave  forms  of  in- 
sanity. The  borderland  cases  and  the  incipient  mild 
forms  alone  allow  the  hope  of  a  cure.  Outside  of 
them  the  work  of  psychotherapy  in  the  insane  asylum 
meant  essentially  improvement  and  relief  only. 
Again,  in  another  direction,  the  general  dietetic  influ- 
ence of  sound  mental  life  may  be  called  a  part  of 
psychotherapy  and  this  engaged  not  a  few  of  the 
leading  medical  thinkers  in  all  countries  during  the 
last  century,  especially  the  nerve  physicians  who  gave 
serious  attention  to  the  wholesome  engagements  of 
the  mind.  Finally,  might  not  much  be  attributed  to 
psychotherapy,  which  offically  belongs  to  the  doc- 
trines of  homeopathy? 

But  we  may  return  to  the  new  heralds  of  sugges- 
tion. Liebeault's  book  on  the  artificial  sleep  in  1866 
became  the  starting  point  of  the  new  great  move- 
ment. Yet  at  first  it  remained  unnoticed.  It  is 
claimed  that  for  a  long  time  only  one  copy  was  sold. 
But  he  continued  to  make  his  hypnotic  experiments  on 
the  poor  population  of  Nancy  and  they  finally  at- 
tracted the  attention  of  some  of  the  leading  medical 
men  there.  Bernheim  became  convinced  and  Du- 
mont,  the  physiologist  Beaunis  joined  the  movement, 
and  in  the  eighties  we  find  Nancy  the  center  of  hyp- 
notic interest  to  which  medical  men  from  everywhere 
made  their  pilgrimage.  This  latter  phase  was  paral- 
leled by  Charcot's  studies  in  Paris,  who  brought  hyp- 


356  PSYCHOTHERAPY 

notism  into  nearest  neighborhood  with  hysteria.  And 
also  the  later  development  of  the  Paris  school  by 
Richer,  and  especially  the  brilliant  work  of  Janet,  kept 
hysteria  in  the  foreground  of  the  therapeutic  interest. 
Liebeault's  experiment  had  brought  the  psychology 
of  suggestion  entirely  into  the  center  of  this  whole 
circle  of  phenomena  and  this  view  controlled  the  de- 
velopment of  the  last  few  decades,  which  was  essen- 
tially an  elaboration  of  the  special  treatment  of  dis- 
eases. Forel  in  Switzerland,  Moll  and  Vogt  in  Ger- 
many, Wetterstrand  in  Sweden  became  the  chief  ex- 
ponents of  therapy  by  hypnotism.  Others,  like  Du- 
bois,  in  Switzerland,  emphasized  more  the  suggestive 
treatment  through  persuasion.  In  England  at  first 
Carpenter,  later  Hack-Tuke  gave  serious  attention  to 
hypnotism,  in  Russia  Bechterew,  and  in  the  last  few 
years  the  literature  on  therapy  by  suggestion  became 
developed  in  practically  all  countries.  In  America 
Beard,  Hammond,  and  others  belong  to  the  older 
school;  Osgood,  Prince,  Peterson,  Putnam,  Sidis,  and 
others  to  the  most  recent  years.  At  the  same  time, 
under  the  leadership  of  Kraepelin,  Ziehen,  Sommer, 
and  others,  the  methods  of  the  psychological  labora- 
tory, especially  the  reaction  and  association  methods, 
were  made  useful  for  the  purposes  of  psychopathology. 
But  interest  in  suggestion  does  not  represent  to- 
day the  last  step  of  psychotherapy.  The  latest  move- 
ment, which  is  entirely  in  its  beginning,  the  develop- 
ment of  which  no  one  can  foresee,  but  which  promises 
wide  perspectives,  is  connected  with  the  name  of 
Freud  in  Vienna.  The  entirely  new  turn  of  psycho- 


AND  THE  PHYSICIAN  357 

therapy  is  given  by  the  fact  that  his  aim  is  not  to 
overcome  a  symptom  by  suggestion  but  to  make  it 
disappear  by  removing  the  ultimate  mental  cause. 
He  found  that  large  groups  of  mental  disturbances 
result  from  a  psychical  trauma,  a  disagreeable  idea 
which,  inhibited  in  the  mind,  becomes  the  source  of 
mischief  and  produces  phobias  and  obsessions  and 
hysterical  motions.  The  cure  of  the  symptoms  de- 
mands the  recognition  of  this  first  mental  accident, 
which  may  lie  back  for  years  and  which  may  no  longer 
be  in  the  memory  of  the  patient.  As  soon  as  this 
earlier  experience  is  brought  to  consciousness  again, 
it  needs  only  a  natural  discharge  and  a  normal  ex- 
pression and  the  symptoms  which  it  brought  about 
will  disappear.  Thus  the  cure  itself  needs  no  hyp- 
notism and  no  persuasion  or  suggestion  but  the  re- 
awakening of  forgotten  situations,  and  only  in  the 
service  of  this  effort  hypnotism  may  be  used  to  ree'n- 
force  the  memory.  Yet  this  represents  only  the  first 
period  of  Freud's  activity,  in  which  he  collaborated 
with  Breuer,  a  phase  which  is  represented  by  their 
book  on  hysteria,  in  1895.  But  there  followed  a  fur- 
ther development  which  is  still  more  essential.  The 
hysterical  disturbance  may  indeed  have  started  with 
such  an  accidental  traumatic  impression  but  that  does 
not  explain  why  just  this  impression  had  such  a  strong 
effect.  Other  impressions  of  equal  strength  and  emo- 
tional vividness  may  have  passed  without  leaving  any 
damaging  result.  And  therefore  there  must  be  some 
prior  cause  in  the  subject  which  makes  just  this  par- 
ticular impression  so  injurious ;  and  here  is  the  point  of 


358  PSYCHOTHERAPY 

Freud's  fundamental  discovery,  which  for  the  layman 
appears  on  the  surface  to  have  little  probability  but 
which  has  proved  of  greatest  consequence  for  clinical 
work.  It  was  found  that  only  those  situations  be- 
come injurious  and  become  starting  points  for  hys- 
terical symptoms  which  touch  on  repressed  and  arti- 
ficially inhibited  ideas  of  the  sexual  sphere. 

Entirely  new  perspectives  have  been  opened  by 
these  studies.  Above  all,  now  for  the  first  time  there 
is  in  sight  a  psychotherapy  which  not  only  aims  to 
remove  symptoms  but  which  really  uproots  the  dis- 
ease itself.  That  earlier  method  of  bringing  the 
trauma  to  consciousness  and  making  it  discharge,  the 
so-called  cathartic  method,  removes  only  the  particu- 
lar group  of  disturbances  but  the  patient  remains  a 
hysteric,  and  if  ever  new  accidents  should  happen 
which  would  touch  again  those  inmost  repressed 
ideas,  new  hysterical  symptoms  would  develop.  But 
if  we  can  go  back  to  that  starting  point,  if  we  can  dis- 
cover those  first  suppressions  of  desired  gratifications 
which  often  most  indirectly  are  related  to  the  sexual 
sphere,  and  if  we  can  liberate  the  mind  from  those 
primary  strangulated  affections,  then  the  patient  is 
really  cured.  Freud  himself  practically  abstained 
from  the  help  which  hypnotism  can  give  for  the  re- 
awakening of  forgotten  experiences,  while  some  of 
his  pupils  still  prefer  this  short  way  to  the  forgotten 
memories.  His  way  is,  on  the  whole,  to  let  the  imagi- 
nation bring  up  any  chance  material  of  associated 
ideas  and  then  to  study  their  connections  and  follow 
the  hints  they  give.  He  calls  it  the  psychoanalytic 


AND  THE  PHYSICIAN  359 

method.  Others  prefer  the  methods  of  association 
tests,  again  others  tap  the  lower  layers  by  automatic 
writing,  but  the  chief  problem  remains  always  to  dis- 
cover those  repressed  desires  and  to  understand 
through  them  the  injurious  effects  of  accidental  ex- 
periences. The  whole  field  of  hysteria,  and  perhaps 
still  more  that  of  the  anxiety  neurosis,  has  come  into 
new  perspective  through  this  pioneer  work  which  men 
like  Bleuler,  Jung,  and  Stekel  have  developed  in  vari- 
ous directions. 

Thus  in  recent  decades  the  thorough  work  of  scien- 
tific physicians  has  developed  a  psychotherapy  of  con- 
siderable extent  and  of  indubitable  usefulness,  far  re- 
moved from  the  simultaneous  efforts  of  the  churches 
and  of  the  popular  mental  healing  cures.  A  number 
of  eminent  men  in  all  countries  have  tested  the 
methods  and  have  published  the  results.  But  the  curi- 
ous side  of  it  is  that  all  this  is  essentially  a  move- 
ment of  leaders  while  the  masses  of  the  profession 
hesitate  to  follow.  It  is  a  set  of  officers  without  an 
army.  Every  large  city  has  one  or  another  specialist 
who  applies  suggestive  therapy,  one  or  another  nerve 
specialist  who  hypnotizes,  but  the  average  physician 
moves  on  without  any  serious  effort  to  utilize  psycho- 
therapy. It  is  as  if  the  prescription  of  the  modern 
chemical  drugs  were  confined  to  some  leading  scholars 
in  the  country,  while  the  thousands  abstained  from  it 
in  their  office  work  and  in  their  family  practice.  In 
reality  psychotherapy  ought  to  be  used  by  every  phy- 
sician, as  it  fits  perfectly  the  needs  of  the  whole  suf- 
fering community.  Its  almost  exceptional  use  in  the 


360  PSYCHOTHERAPY 

hands  of  a  few  scholarly  leaders  deprives  it  of  its 
true  importance.  It  is  the  village  doctor  who  needs 
psychotherapy  much  more  than  he  needs  the  knife 
and  the  electric  current. 

Why  does  the  medical  profession  on  the  whole 
show  this  shyness  in  the  face  of  such  surprising  re- 
sults? In  other  fields  they  do  not  show  any  reluc- 
tance in  taking  up  the  newer  developments  of  method. 
Even  the  Roentgen  ray  apparatus  has  quickly  won 
its  way,  and  psychotherapy  is  less  expensive.  To  be 
sure,  the  most  important  reason  is  probably  one  which 
is  most  honorable.  The  physicians  do  not  like  to 
touch  a  tool  which  has  been  misused  so  badly.  Psy- 
chotherapy has  come  too  much  into  the  neighbor- 
hood of  superstition  and  humbug.  Where  miracles 
are  performed,  the  man  of  science  prefers  to  leave  the 
field.  The  less  one  knows  about  those  groups  of 
problems,  the  less  one  is  able  to  see  the  sharp  demar- 
cation line  between  true  scientific  studies,  for  instance, 
in  hypnotism,  and  the  pseudo-scientific  fancies  of  psy- 
chical research.  Experiments  in  suggestibility  are 
then  easily  mixed  with  experiments  in  telepathy,  and 
those  go  over  by  gradual  degrees  to  clairvoyance  and 
premonitory  apparitions,  and  from  there  the  way  is 
not  far  to  the  reappearance  of  the  dead  and  the  rou- 
tine performances  of  the  spiritists.  It  seems  to  many 
as  if  there  is  no  point  where  they  have  a  reason  to 
stop.  If  they  begin  with  such  abnormal  phenomena 
at  all,  it  seems  as  if  they  are  necessarily  carried  over 
to  all  the  mysteries  of  supernatural  energies.  Even 
the  competition  with  Christian  Science,  and  other 


AND  THE  PHYSICIAN  361 

mental  healers  whose  judgment  is  not  hampered  by 
any  previous  study  of  medicine,  might  seem  rather  un- 
attractive to  the  serious  physician. 

Further  not  a  few  have  the  impression  that  such 
suggestive  treatment  directly  demands  from  them 
that  they  also  begin  to  humbug  their  patients  or  to 
throw  out  suggestions  which  they  themselves  do  not 
believe,  in  short,  that  they  be  brought  down  to  the 
level  of  the  miracle  performer.  Yet,  however  much 
all  that  speaks  in  favor  of  the  conscientious  instinct 
in  the  physician,  it  is  ultimately  based  upon  a  mis- 
interpretation. The  line  between  real  science  and  its 
counterfeit  is  here  as  everywhere  a  distinct  one,  and 
the  true  man  of  science  ought  not  to  hesitate  in  doing 
his  duty  from  fear  that  he  might  not  be  discriminated 
from  the  charlatan.  A  well-conducted  psychothera- 
peutic  treatment  as  a  scientific  physician  ought  to 
carry  it  out,  is  entirely  different  in  meaning  and  ap- 
pearance, from  the  first  step  of  diagnosis  to  the  last 
treatment  of  after-effects,  from  every  unscientific  faith 
cure.  It  is  also  in  no  way  necessary  that  the  psycho- 
therapist ever  leave  the  path  of  complete  sincerity. 
There  is  no  reason  at  all  for  promising  that  the  pa- 
tient will  be  entirely  cured  if  the  physician  believes 
that  a  real  cure  through  suggestion  is  impossible. 
The  more  the  true  physicians  undertake  psychothera- 
peutic  work,  the  more  it  will  carry  with  it  that  dignity 
which  is  now  too  often  lost  by  the  predominance  of 
those  who  treat  without  diagnosis  and  cure  by  mere 
appeal  to  superstition. 

All  that  does  not  mean  that  other  motives  do  not 


362  PSYCHOTHERAPY 

hold  the  physician  back.  Not  seldom  he  is  afraid 
of  unfavorable  consequences.  He  does  not  feel  sure 
that,  for  instance,  a  deep  hypnosis  is  without  danger- 
ous results  or  that  he  will  be  able  to  produce  it  in 
the  technically  correct  way.  But  all  these  objections 
mean  nothing  but  insufficient  acquaintance  with  the 
facts.  Of  course  every  technique  needs  its  period  of 
preparation  for  the  task,  but  it  is  now  sufficiently 
demonstrated  that  hypnotism  carried  through  in  a 
scientific  spirit  will  never  have  any  injurious  conse- 
quences. The  morphine  injection  and  the  Roentgen 
rays  are  by  far  more  dangerous.  Those  who  think 
that  for  hypnotizing  especially  inborn  power  is 
needed  stand,  of  course,  outside  of  a  serious  discus- 
sion. They  do  not  even  know  the  elements  of  the 
modern  theories.  Every  physician  has  in  himself  the 
necessary  means  for  a  psychotherapeutic  treatment  in 
every  form. 

More  scientific  insight  belongs  to  the  argument 
that  most  of  these  psychotherapeutic  schemes  are  es- 
sentially for  treatment  of  symptoms.  We  have  ac- 
knowledged that  throughout.  The  possibility  of  a 
relapse  or  of  a  new  obsession  is  thus  to  a  high  degree 
open,  and  that  is  certainly  a  discouraging  feature. 
Yet  we  have  seen  sufficiently  that  as  soon  as  the  symp- 
toms are  removed,  there  is  no  lack  of  means,  also  by 
psychotherapy,  to  prevent  the  recurrence.  Moreover, 
to  remove  the  present  symptoms  is  in  any  case  a  great 
gain  and  in  many  cases  a  decisive  gain.  And  what- 
ever can  be  secured  by  such  methods  is  of  such  a 
character  that  hardly  any  other  method  could  have 


AND  THE  PHYSICIAN  363 

been  substituted.  It  can  be  said  with  certainty  that 
hundreds  of  thousands  leave  the  offices  of  their  doc- 
tors every  year  without  relief  where  relief  could  be 
secured  by  psychotherapeutic  means. 

To  be  sure,  one  reply  of  the  physicians  is  not  in- 
frequent and  carries  some  weight.  Psychotherapeu- 
tic methods  demand  much  time  and  patience  and  skill. 
To  relieve  a  cocainist  of  his  desire  by  mere  suggestion 
may  demand  an  assiduity  which  the  average  physician 
simply  cannot  afford;  and  nothing  requires  more  time 
than  a  real  use  of  Freud's  psychoanalytic  method. 
Hours  and  hours  of  conversation  about  the  most  triv- 
ial occurrences  have  to  be  spent  to  relieve  the  re- 
pressed ideas  and  to  give  them  a  chance  for  a  free 
ascension.  It  cannot  be  denied  that  most  of  the  really 
illuminating  work  in  all  these  fields  has  been  done  by 
scholars  who  combine  a  strong  theoretical  interest 
with  their  effort  to  cure  the  patients,  and  who  there- 
fore examine  and  treat  the  individual  case  primarily 
from  the  wish  to  get  new  insight  into  the  laws  of 
nature.  The  average  physician  whose  time  is  his  in- 
come may  be  the  less  willing  to  enter  into  such  time- 
devouring  schemes,  as  the  patients  too  easily  may 
think  that  the  physician  did  not  do  much  for  them 
when  he  simply  was  sitting  down  and  gossiping  with 
them. 

Yet  after  all,  behind  all  of  it  stands  one  motive 
which  has  held  back  the  development  of  psycho- 
therapy in  the  medical  profession  more  than  anything 
else.  The  physician  feels  instinctively  that  a  real  suc- 
cess can  be  reached  in  every  one  of  these  fields,  only 


364  PSYCHOTHERAPY, 

if  he  possesses  a  reasonable  amount  of  knowledge  of 
psychology.  He  feels  that  wherever  he  touches  the 
patient's  body,  examines  his  lungs  or  his  heart  or  his 
reflexes,  that  a  large  background  of  anatomical  knowl- 
edge and  of  general  pathology  gives  meaning  to  every 
single  observation.  But  in  the  field  of  mental  ab- 
normities, in  the  whole  world  of  ideas  and  emotions 
and  volitions,  he  simply  lacks  that  background. 
Everything  seems  to  him  without  reference  to  real 
knowledge.  He  feels  as  amateurish  as  if  he  were  to 
operate  on  the  abdomen  without  knowing  its  anat- 
omy. He  is  instinctively  aware  that  even  the  sim- 
plest mental  life  represents  a  bewildering  complexity 
and  that  to  stimulate  ideas  or  feelings  or  to  suppress 
emotions,  to  inhibit  volitions,  must  demand  always  a 
most  subtle  disentanglement  of  the  most  widely  dif- 
ferent components.  He  abstains  from  approaching 
that  ground  at  all  rather  than  to  blunder  by  his  ig- 
norance of  psychology.  And  after  all,  he  is  right. 
But  is  he  right  in  allowing  that  ignorance?  Can  the 
medical  profession  afford  to  send  into  the  world  every 
year  thousands  of  young  doctors  who  are  unable  to 
use  some  of  the  most  effective  tools  of  modern  medi- 
cine, and  tools  which  do  not  belong  to  the  specialist 
but  just  to  the  average  practitioner,  simply  because 
they  have  not  learned  any  psychology? 

Indeed  the  times  seem  ripe  for  a  systematic  intro- 
duction of  psychological  studies  into  every  regular 
medical  course.  It  is  not  a  question  of  mental  re- 
search in  the  psychological  laboratory  where  advanced 
work  is  carried  on,  but  a  solid  foundation  in  empir- 


AND  THE  PHYSICIAN  365 

ical  psychology  can  be  demanded  of  everyone.  He 
ought  to  have  as  much  psychology  as  he  has  physi- 
ology. Moreover  the  psychological  study  ought  not 
to  be  confined  to  the  normal  mental  life.  Again  we 
do  not  speak  of  psychiatry.  What  is  needed  is  ab- 
normal psychology,  entirely  independent  of  the  thera- 
peutic interests  of  the  alienist.  The  mental  varia- 
tions within  the  limits  of  normal  life  and  the  border- 
land cases  ought  to  be  studied  there  as  well  as  the 
complete  derangements.  The  ideal  demand  would 
be  that  the  future  physician  should  spend  at  least  a 
year  of  his  undergraduate  time  on  empirical  psy- 
chology, especially  on  experimental  and  physiological 
psychology.  He  would  take  perhaps  half  a  year's 
lecture  course  on  the  whole  field  of  psychology  as 
covered  in  the  English  language  by  the  well-known 
text-books  of  James,  Wundt,  Titchener,  Judd,  Royce, 
Calkins,  Angell,  Baldwin,  Kuelpe,  Ebbinghaus, 
Thorndike,  Stout,  Ziehen,  Ladd,  and  so  on.  In  the 
second  half-year  the  course  ought  to  be  either  ad- 
vanced psychology  entering  into  the  more  complex 
phenomena  or  a  practical  training  course  in  element- 
ary laboratory  psychology  as  indicated  for  instance  by 
Titchener's  "  Experimental  Psychology.  A  Manual 
of  Laboratory  Practice."  If  the  undergraduate  can 
possibly  afford  the  time  in  his  college  course,  he  ought 
to  add  courses  which  either  lead  him  towards  the 
philosophical  problems  of  psychology  or  towards  tfie 
comparative  aspect  of  psychology.  If  he  can  find 
time  for  a  year  of  post-graduate  work  between  col- 
lege and  medical  school,  he  could  hardly  spend  it 


366  PSYCHOTHERAPY* 

more  profitably  than  by  a  year  of  research  in  a  well- 
conducted  psychological  laboratory  to  become  really 
acquainted  with  an  independent  analysis  of  mental 
states.  On  the  other  hand  in  the  medical  school,  room 
must  be  found  for  a  course  in  abnormal  psychology, 
which  of  course  presupposes  a  thorough  knowledge 
of  normal  psychology  and,  if  possible,  follows  the 
courses  on  nervous  diseases  and  precedes  the  course 
on  psychiatry. 

For  the  average  future  physician,  it  would  be 
wiser  to  omit  even  the  psychiatry  studies  than  those 
in  abnormal  psychology.  The  latter  ought  to  lead 
him  far  enough  to  discriminate  early  between  a  mere 
neurasthenia,  for  instance,  and  a  beginning  of  in- 
sanity. As  soon  as  the  discrimination  is  perfected 
and  insanity  is  found,  he  has  to  give  the  case  out  of 
his  care  anyhow  and  hand  it  over  to  the  specialist  and 
to  the  asylum.  The  knowledge  of  psychiatric  treat- 
ment is,  therefore,  not  essential  for  the  average  prac- 
titioner. But  no  one  can  relieve  him  from  the  re- 
sponsibility for  those  borderland  cases,  for  the  hys- 
terias and  psychasthenias  and  neurasthenias,  and  he 
can  never  master  them  without  normal  and  abnormal 
psychology.  Moreover  it  must  not  be  forgotten  that 
mental  factors  may  enter  into  every  disease.  The 
psychology  of  pain,  for  instance,  and  of  comfort  feel- 
ing, the  psychology  of  hunger  and  thirst,  of  nausea 
and  dizziness,  the  psychology  of  the  sexual  feelings, 
the  psychology  of  hope  and  fear,  of  confidence  and 
discouragement,  of  laziness  and  energy,  of  sincerity 
and  cunningness  play  their  role  in  almost  every  sick 


AND  THE  PHYSICIAN  367 

room.  And  if  the  physician  haughtily  declares  that  he 
does  not  care  for  the  methods  of  suggestion,  it  might 
justly  be  asked  whether  he  can  be  a  physician  at  all  if 
he  does  not  apply  some  suggestions ;  yes,  if  his  very  en- 
trance into  the  sick  room  does  not  suggest  relief  and 
improvement  from  the  start.  The  introduction  of  a 
serious  study  of  psychology  is  the  most  immediate 
need  of  the  medical  curriculum.  Instructorships  in 
abnormal  psychology  must  be  created  in  every  med- 
ical school;  institutes  for  psychotherapy  should  soon 
follow.  But  in  all  this,  there  is  nowhere  to  appear 
any  artificial  antithesis  between  mind  and  body,  any 
more  than  between  organic  and  functional  diseases; 
we  have  discussed  all  that  with  full  detail.  Only  the 
physician  who  has  a  thorough  psychological  prepara- 
tion can  fulfill  the  manifold  demands  which  modern 
life  must  raise ;  he  alone  is  prepared  to  cooperate  with 
the  other  factors  of  the  community  in  the  develop- 
ment of  a  sound  and  healthful  nation,  to  work  to- 
wards the  hygiene  of  the  nervous  system  and  of  the 
mental  life;  and  to  correct  the  injuries  which  the  per- 
versities of  our  civilization  inflict. 

In  all  that  he  will  not  avoid  the  comradeship  of 
the  clergyman.  He  will,  of  course,  not  forget  the 
fundamental  difference  of  attitude  between  them,  he 
will  not  forget  that  the  minister  seeks  for  the  mean- 
ing and  values  of  inner  life  while  he,  the  physician, 
has  to  consider  that  same  inner  life  from  a  causal 
point  of  view  and  thus  has  to  work  with  it  as  with 
natural  material  for  the  normal  functioning  of  the 
organism.  But  the  interrelation  between  them  can 


368  PSYCHOTHERAPY 

be  intimate  in  spite  of  the  difference  of  their  stand- 
points. The  minister,  to  be  sure,  ought  not  to  con- 
sider health  as  such  as  the  greatest  good,  but  he  will 
not  forget  that  a  wholesome  devotion  to  ideals  cannot 
be  carried  through  when  the  attention  is  absorbed  by 
the  sufferings  of  the  body  and  the  mental  powers  are 
debilitated.  Only  in  a  sound  mind  the  full  ideal 
meanings  of  life  can  be  realized.  The  minister  must 
therefore  seek  the  health  of  his  congregation  not  be- 
cause health  is  the  ideal  of  life  but  because  the  true 
ideals  cannot  be  appreciated  by  the  mental  cripple. 
On  the  other  hand,  the  physician  from  his  standpoint 
should  in  no  way  feel  it  his  duty  to  play  the  amateur 
minister  and  to  put  emphasis  on  the  spiritual  uplift- 
ing of  his  patients.  But  he  knows  well  that  not  a  few 
of  the  suggestive  influences  which  are  needed  for  the 
relief  from  disease  are  most  effective  when  an  emo- 
tional emphasis  can  be  given  to  the  suggestions  and 
that  this  emphasis  is  for  large  numbers  most  power- 
fully supplied  by  the  religious  emotion.  Thus  the 
minister  will  be  a  very  important  assistant  to  him  and 
the  church  will  most  successfully  do  for  many  pa- 
tients what  for  other  patients  perhaps  travel  or  music 
or  the  theatre,  sport  or  social  life,  may  do. 

Just  in  the  relation  to  the  church,  the  physician  will 
need  subtlest  discrimination,  and  he  will  not  forget 
that  while  even  a  strong  religious  emotion  may  be 
without  damage  for  a  normal  man,  it  may  well  be  in- 
jurious to  the  unstable  brain.  But  if  the  physician 
uses  tact  and  wisdom,  he  will  be  surprised  to  find  how 
often  the  religious  stimulation  can  indeed  be  helpful 


AND  THE  PHYSICIAN  369 

for  his  purposes  and  the  division  of  labor  demands 
that  this  be  supplied  not  by  himself  but  by  the 
minister.  He  will  advise  the  consulting  sufferer  to 
seek  the  influence  of  a  godly  man  who  awakens  in 
him  upbuilding  wholesome  emotions  and  volitions. 
The  minister  may  in  this  way  very  well  become  the 
assistant  of  the  physician.  But  whether  this  coopera- 
tion is  looked  on  from  the  one  or  from  the  other  point 
of  view,  in  every  case  it  needs  absolute  clearness. 
Nothing  is  gained  and  too  much  is  lost  if  the  two 
functions  are  carelessly  mixed  together.  It  is  never 
the  task  of  the  minister  to  heal  a  mind  and  never  the 
task  of  a  physician  to  uplift  a  mind.  One  moves  in 
the  purposive  sphere,  the  other  in  the  causal  sphere. 
Their  friendship  can  seriously  endure  only  as  long 
as  they  remain  conscious  of  the  fact  that  they  have 
two  entirely  different  functions  in  the  service  of  man- 
kind. 


XIV 
PSYCHOTHERAPY  AND  THE  COMMUNITY 

BOTH    the    physician    and    the    patient    find 
their  place   in   the   community   the   life   in- 
terests   of   which    are    superior    to    the    in- 
terests  of   the    individual.      It    is    an   unavoidable 
question  how  far  from  the  higher  point  of  view 
of   the    social   mind    the    psychotherapeutic    efforts 
should  be  encouraged  or  suppressed.     Are  there  any 
conditions  which  suggest  suspicion  of  or  direct  op- 
position to  such  curative  work? 

Of  course  society  has  to  be  sure  that  no  possible 
misuse  and  damage  are  to  result  from  such  practice. 
Fears  in  that  direction  have  been  uttered  repeatedly, 
but  from  very  different  standpoints.  One  which  is 
perhaps  most  often  heard  in  popular  circles  results 
from  an  entire  misunderstanding  and  deserves  hardly 
any  discussion  after  our  detailed  study  of  the  proc- 
esses involved.  It  is  claimed  that  suggestive  power, 
especially  in  the  form  of  hypnotization,  may  be 
secretly  misused  to  make  anyone  without  his  knowl- 
edge and  against  his  will  a  passive  instrument  of  the 
hypnotist's  intent.  Often  this  is  coupled  with  tele- 
pathic fancies.  The  hypnotist  is  believed  to  have 
mystic  power  to  bring  any  person  in  a  distant  region 

370 


AND  THE  COMMUNITY  371 

under  his  mental  control  and  thus  to  be  able  to  carry 
out  any  sinister  plans  by  the  help  of  his  innocent 
victim.  All  hypnotizing  therefore  ought  to  be  inter- 
dicted by  the  state.  The  presuppositions  of  such  a 
view  are,  as  we  know  now,  entirely  absurd.  We 
know  that  hypnotism  is  not  based  on  any  special 
power  of  the  hypnotizer;  there  is  no  magnetic  fluid  in 
the  sense  of  the  old  mesmerism.  The  imagination  of 
the  hypnotized  person  is  the  only  hypnotizing  agency. 
Thus  no  one  can  be  hypnotized  without  his  knowl- 
edge or  against  his  will.  The  story  of  telepathic 
mysteries  which  is  often  brought  before  the  public 
is  probably  always  the  outcome  of  a  diseased  brain. 
It  is  indeed  a  frequent  symptom  in  paranoia  and 
other  insanities  that  the  patient  who  feels  abnormal 
organic  sensations  and  abnormal  unaccountable  im- 
pulses interprets  them  as  influences  of  a  distant 
enemy.  Whole  pamphlets  have  been  written  with 
elaboration  of  such  insane  misinterpretations  and  re- 
quests to  legislatures  have  been  made  in  that  spirit, 
but  the  physician  recognizes  easily  throughout  the 
whole  argumentation  the  well-known  phenomena  of 
the  mental  disease. 

To  be  sure,  while  no  one  can  be  hypnotized  against 
his  will,  many  a  person  is  liable  to  accept  suggestions 
from  others  and  thus  to  carry  out  the  wishes  of  others 
almost  without  knowing  and  certainly  without  will- 
ing that  the  other  mind  interfere  with  the  interplay 
of  the  own  motives.  But  if  we  were  to  strike  out  all 
suggestive  influences  from  social  life,  we  should  give 
up  social  life  itself.  Suggestion  is  given  wherever 


372 


PSYCHOTHERAPY 


men  come  in  contact;  in  itself  it  is  neither  good  nor 
bad.  The  good  resolution  and  the  bad  one  can  be 
suggested,  the  good  example  and  the  bad  can  be 
effective ;  both  encouragement  of  the  noble  and  imita- 
tion of  the  evil  may  work  with  the  same  mental 
technique.  Certainly  there  are  some  persons  who 
have  a  stronger  influence  than  others  on  the  imagina- 
tion of  those  with  whom  they  come  in  contact;  their 
expression  awakens  confidence,  their  voice  and  their 
words  reach  deeper  layers  of  the  mind,  their  calm- 
ness and  firmness  overwhelm  more  easily  the  antago- 
nistic ideas.  But  the  chief  difference  lies  after  all 
in  the  different  degrees  of  suggestibility  among  those 
who  receive  such  impressions.  The  easily  suggest- 
ible person  cannot  be  protected  by  any  interdict; 
he  may  catch  suggestions  everywhere,  any  ad- 
vertisement in  the  newspaper  and  any  display  in 
the  shop-window  may  overrun  his  own  intentions. 
What  he  needs  is  training  in  firmness.  The  applica- 
tion of  reenforced  suggestion  or  even  of  hypnotism  in 
the  doctor's  office  is  even  for  him  no  possible  source 
of  danger. 

On  a  higher  level  are  objections  which  come  from 
serious  quarters  and  which  are  not  without  sympathy 
with  true  science.  In  recent  times  this  opposition 
has  repeatedly  found  eloquent  expression.  It  is  an 
objection  from  the  standpoint  of  morality,  belonging 
therefore  entirely  to  the  purposive  view  of  the  mind, 
but  we  have  now  reached  a  point  where  it  is  our  duty 
to  do  justice  to  this  purposive  view  too.  As  long  as 
we  discussed  the  problem  entirely  from  the  stand- 


AND  THE  COMMUNITY  373 

point  of  the  physician,  no  other  view  of  mental  life 
except  the  causal  one  could  be  in  question.  As  soon 
as  we  look  at  it  from  the  standpoint  of  the  com- 
munity, it  becomes  our  duty  to  bring  the  causal  and 
the  purposive  view  into  harmony,  and  it  would  be 
narrow  and  shortsighted  simply  to  draw  the  practical 
consequences  of  a  naturalistic  view  of  the  mind  with- 
out inquiring  whether  or  not  serious  interests  in  the 
purposive  sphere  are  injured.  If  there  is  moral  criti- 
cism against  suggestive  therapy,  it  is  the  duty  of  the 
community  to  consider  it.  This  opposition  argues  as 
follows :  Hypnotic  influence  brings  the  patient  under 
the  will  control  of  the  hypnotizer  and  thus  destroys 
his  own  freedom.  Whatever  the  patient  may  reach 
in  the  altered  states  is  reached  without  his  own  effort, 
while  he  is  the  passive  receiver  of  the  other  man's 
will.  His  achievement  has  therefore  no  moral 
value,  and  if  he  is  really  cured  of  his  drunkenness  or 
of  his  perverse  habits,  of  his  misuse  of  cocaine  or  of 
his  criminal  tendencies,  he  has  lost  the  right  to  be 
counted  a  moral  agent.  It  would  be  better  if  there 
were  more  suffering  in  the  world  than  that  the  exist- 
ence of  the  moral  will  should  be  undermined. 

No  one  ought  to  take  such  arguments  lightly.  The 
spirit  which  directs  them  is  needed  more  than  any- 
thing else  in  our  time  of  reaching  out  for  superficial 
goods.  No  one  can  insist  too  earnestly  that  life  is 
worth  living  only  if  it  serves  moral  duties  and  moral 
freedom  and  is  not  determined  by  pleasures  and  ab- 
sence of  pain  only.  Those  who  set  forth  this  argu- 
ment are  entirely  willing  to  acknowledge  the  pro- 


374 


PSYCHOTHERAPY 


found  effect  which  suggestive  therapeutics  may 
create.  More  than  this,  they  have  to  acknowledge 
it  to  gain  a  basis  for  their  attack.  Just  because  the 
hypnotizer  can  entirely  change  the  desires  and  pas- 
sions, the  habits  and  perversities  of  the  suffering  vic- 
tim, he  seems  to  them  a  moral  wrongdoer  who 
negates  the  principle  of  human  freedom.  A  forcible 
book  of  recent  days  calls  the  suggestive  power  of  the 
psychotherapist  "  The  Great  Psychological  Crime." 
It  says  to  the  hypnotist :  "  By  your  own  testimony, 
you  stand  convicted  of  applying  a  process  which  de- 
prives your  subjects  of  the  inalienable  right  and  power 
of  individual  self-control.  In  proportion  as  you  de- 
prive him  of  the  power  of  self-control,  you  deprive 
him  of  that  upon  which  his  individual  responsibility 
and  moral  status  depend.  In  proportion  as  you  de- 
prive him  of  the  free  control  and  exercise  of  those 
powers  of  the  soul  upon  which  his  individual  responsi- 
bility and  moral  status  depend,  you  thereby  rob  him 
of  those  powers  upon  which  he  must  depend  for  the 
achievement  of  individual  immortality." 

But  this  censure  too  is  entirely  mistaken,  not  be- 
cause it  urges  the  purposive  views  against  the  causal 
but  because  it  is  in  error  as  to  the  facts.  Such  critics 
are  fully  under  the  influence  of  the  startling  results 
which  are  reached ;  they  do  not  take  the  trouble  to  ex- 
amine the  long  and  difficult  way  which  has  had  to  be 
traversed  with  patience  and  energy.  It  is  quite  true 
that  if  I  hypnotize  a  man  and  suggest  to  him  to  take 
up  after  awaking  the  book  which  lies  on  my  table, 
i  he  follows  my  suggestion  without  conflict  and  in  a 


AND  THE  COMMUNITY  375 

certain  sense  without  freedom.  He  feels  a  simple 
impulse  to  go  to  the  table  and  lift  the  book  and,  as 
no  stronger  natural  desire  and  no  moral  objection 
stand  in  the  way,  he  carries  out  that  meaningless  im- 
pulse and  perhaps  even  invents  a  foolish  motive  to 
explain  to  himself  why  he  wanted  to  look  at  that 
book.  But  after  a  long  experience,  I  have  my  doubts 
as  to  whether  a  man  was  ever  cured  in  such  a  way  by 
hypnotism  of  serious  disturbances  and  of  those 
anomalous  actions  which  the  critics  want  to  see  over- 
come by  the  patient's  own  moral  efforts.  On  the 
contrary,  every  suggestion  has  to  rely  on  the  efforts 
and  struggles  of  the  patient  himself  and  all  that  the 
psychotherapists  can  give  him  is  help  in  his  own 
moral  fight.  His  own  will  is  presupposition  for 
being  hypnotized  and  for  realizing  the  suggestion. 
If  again  and  again  I  hesitate  to  undertake  new  cases, 
it  is  just  because  I  have  to  see  during  the  treatment 
too  much  of  this  daily  and  hourly  striving  against 
overpowering  impulses.  The  joy  of  removing  some 
obstacles  from  the  way  of  the  patients  is  too  much 
overshadowed  by  the  deep  pity  and  sympathy  with 
their  suffering  and  craving  during  the  whole  period 
of  successive  treatments.  To  make  a  man  fight 
where  despair  is  inevitable,  and  where  the  enemy  is 
necessarily  stronger  than  his  own  powers,  can  cer- 
tainly not  be  the  moral  demand.  Morality  postu- 
lates that  everyone  find  conditions  in  which  he  can 
be  victorious  if  he  puts  his  strongest  efforts  to  the 
task. 

In  our  discussion  of  the  mental  symptoms  I  re- 


376  PSYCHOTHERAPY 

ported  as  an  illustration  of  the  suggestive  treatment 
of  the  drug  passion  the  case  of  a  morphinist.  To 
make  clear  this  purposive  side  of  the  case  as  against 
the  causal  one  which  alone  interested  the  physician, 
I  may  add  a  few  features  to  the  short  report  as  a 
typical  example.  When  that  man  left  my  labora- 
tory for  the  last  time  to  go  out  to  work  and  happi- 
ness, you  might  well  have  believed  from  his  joyful 
face  that  it  had  been  an  easy  and  pleasant  time  in 
which  hypnotic  influence  smoothly  removed  from  him 
the  dangerous  desire  for  morphine.  In  truth  it  was  the 
result  of  four  months  of  the  most  noble  and  courage- 
ous suffering  and  struggling.  He  had  been  for  years 
a  slave  to  his  passion.  To  quote  from  his  little  auto- 
biography:  "  When  I  realized  that  I  was  addicted  to 
morphine,  I  was  at  first  not  at  all  worried  as  I  did 
not  then  understand  the  real  horror  of  the  thing,  and 
did  not  then  realize  all  the  future  suffering  and 
misery  that  is  coming  to  anyone  who  is  the  user  of 
opium  or  any  of  its  alkaloids.  For  the  first  few 
months,  I  found  great  relief  after  every  injection  of 
morphine,  but  soon  I  could  not  get  the  same  easy 
feeling  and  could  eat  but  very  little  and  what  sleep 
I  got  was  in  the  daytime.  I  finally  went  to  the  sani- 
tarium of  a  doctor  but  it  was  simply  a  money-making 
business  for  him;  if  he  ever  cured  anyone,  I  never 
heard  of  it.  I  then  tried  another  one;  it  was  the 
same  kind  of  a  place  as  the  former.  When  I  first 
went  to  see  the  professor  in  the  Harvard  Psycholog- 
ical Laboratory,  I  was  using  between  thirty-two  and 
thirty-eight  grains  of  morphine  daily.  He  put  me 


AND  THE  COMMUNITY  377 

under  his  treatment  October  6th  and  that  day  cut  me 
down  by  hypnotic  treatment  to  nine  grains  a  day  or 
three  doses  of  three  grains  a  day.  I  took  my  hypo- 
dermic as  directed,  but  on  the  following  day  I  lay 
on  the  bed  too  exhausted  to  get  up  even  to  get 
around  the  room,  and  I  could  not  eat  and  only  drank 
a  very  little  water.  The  desire  for  the  drug  was 
something  terrible.  But  in  about  four  days  I  got 
used  to  the  loss  of  so  much  morphine  and  stayed  on 
this  amount  for  a  week,  seeing  the  professor  every 
other  day  for  hypnotic  treatment  and  then  returning 
to  my  room  where  I  spent  twenty-two  hours  of  the 
twenty-four  on  the  bed,  but  did  not  sleep  more  than 
two  or  three  hours  a  day.  At  the  end  of  the  week 
I  was  cut  off  by  hypnotic  suggestion  half  a  grain  and 
this  put  me  to  fighting  the  desire  again.  This  lasted 
two  or  three  days  and  then  I  began  to  feel  better  and 
began  to  sleep  a  little  more.  But  at  the  end  of  the 
week  I  was  cut  off  another  half  grain,  and  the  whole 
fight  would  have  to  be  begun  over.  These  reduc- 
tions of  the  dose  were  made  a  week  apart  and  some- 
times only  two  days.  The  worst  time  of  all  was  a 
cut  from  four  injections  of  a  fourth  of  a  grain  each 
to  four  of  one  eighth  of  a  grain  each,  which  was 
about  January  loth.  At  this  time  I  had  the  worst 
two  days  of  my  life.  I  tried  whiskey,  but  it  gave 
relief  only  for  about  half  an  hour  and  then  the  desire 
was  worse  than  ever." 

In  this  way  every  few  days  I  gave  the  poor  fel- 
low under  hypnotic  influence  the  suggestion  to  reduce 
the  dose  of  morphine  in  a  prescribed  way,  and  with 


378  PSYCHOTHERAPY 

enormous  effort  he  withstood  his  craving  for  more, 
in  spite  of  the  fact  that  he  had  during  all  this  winter 
a  bottle  with  a  thousand  tablets  of  morphine,  pre- 
scribed by  an  unscrupulous  physician,  in  his  writing 
desk.  He  was  thus  at  every  moment  during  the  day 
and  night  in  full  possession  of  the  deadly  poison  with 
which  he  could  have  fully  satisfied  his  craving.  It 
was  a  moral  victory  when  he  finally  reached  the  point 
at  which  he  went  for  several  weeks  without  any  de- 
sire for  morphine  and  finally  presented  the  remaining 
tablets  to  a  hospital.  And  yet  there  would  not  have 
been  the  least  chance  for  his  winning  this  ethical 
victory  without  the  outer  help  of  the  hypnotist.  We 
do  not  eliminate  the  moral  will  but  we  remove  some 
unfair  obstacles  from  its  path.  We  have  no  mystic 
power  by  which  our  will  simply  takes  hold  of  the 
other  man's  will,  but  we  inhibit  and  suppress  by  in- 
fluence on  the  imagination  those  abnormal  impulses 
which  resist  the  sound  desires.  If  that  were  im- 
moral, we  should  have  to  make  up  our  minds  that 
all  education  and  training  were  perverted  with  such 
immoral  elements.  Every  sound  respect  for  author- 
ity which  makes  a  child  willing  to  accept  the  advice 
and  maxims  of  his  elders  is  just  such  an  influence. 
If  it  were  really  a  moral  demand  that  the  will  be  left 
to  its  own  resources  and  that  no  outside  influence 
come  to  strengthen  its  power  or  remove  its  hindrances 
or  smooth  its  path,  then  we  ought  to  let  the  children 
grow  up  as  nature  created  them  and  ought  not  to 
try  to  suppress  from  without  by  discipline  and  train- 
ing, by  love  and  encouragement,  the  willful  impulses 


AND  THE  COMMUNITY  379 

and  the  ugly  habits.  Even  every  good  model  for 
imitation  is  such  a  suggestive  influence  from  without 
and  every  solemn  appeal  to  loyalty  and  friendship, 
to  patriotism  and  religion,  increases  the  degree  of 
suggestibility.  That  is  the  glory  of  life  that  the 
suggestive  power  may  belong  to  moral  values  instead 
of  mere  pleasures,  but  it  is  not  the  aim  of  life  to 
remain  untouched  by  suggestion.  And  he  who  by 
suggestion  helps  the  weak  mind  to  overcome  ob- 
stacles which  the  strong  mind  can  overthrow  from  its 
inborn  resources  works  for  the  good  of  the  individual 
and  of  the  community  in  the  spirit  of  truest  morality. 
Much  more  justified  than  such  ethical  objections 
are  the  fears  which  move  entirely  in  the  causal 
sphere.  It  must  be  acknowledged  that  a  method 
which  has  such  powerful  influence  over  the  mind  that 
it  can  secure  ideas  and  emotions  and  impulses  which 
the  own  will  of  the  patient  cannot  produce,  ought  to 
be  allowed  only  to  those  who  are  prepared  for  its  skill- 
ful use.  To  hypnotize  or  to  perform  any  persistent 
psychotherapeutic  treatment  may  thus  be  dangerous, 
if  it  is  done  by  the  unfit.  We  have  discussed  before 
the  injuries  which  might  result  from  the  administra- 
tion of  such  powerful  psychotherapeutic  effects 
through  the  best  meaning  minister,  but  we  can  extend 
this  fear  to  anyone  who  has  not  systematically  studied 
medicine  and  to  a  certain  degree  normal  and  ab- 
normal psychology.  The  possibilities  of  overlook- 
ing symptoms  which  ought  to  suggest  an  entirely  dif- 
ferent treatment,  or  of  adjusting  the  treatment  badly 
to  the  special  physical  conditions,  or  of  ignoring  the 


380  PSYCHOTHERAPY 

desirable  physical  supplement  by  drugs,  or  of  creating 
unintentionally  by  suggestion  injurious  effects,  are 
always  open  when  medical  amateurs  undertake  such 
work.  Certainly  there  is  no  physician  who  is  not 
liable  to  make  mistakes,  and  a  physician  who  has 
never  given  any  attention  to  psychology  and  psy- 
chiatry would  also  be  a  rather  poor  agent  of  psycho- 
therapeutic  methods,  but  the  probability  is  that  such 
a  physician  would  simply  abstain  by  principle  from 
all  psychotherapeutic  methods;  his  mistake  only  be- 
gins if  from  his  lack  of  acquaintance  with  the  subject 
he  draws  the  conclusion  that  the  method  itself  is 
undesirable.  That  his  real  preparation  ought  to  in- 
clude psychological  studies  we  have  pointed  out  be- 
fore, and  the  time  seems  ripe  for  the  community  to 
urge  such  a  reform  of  the  studies. 

All  that  involves  the  conviction  that  even  the  ex- 
perimental psychologist  as  such  is  not  prepared  to 
enter  into  medical  treatment;  and  a  "Psychological 
Clinic,"  managed  by  a  psychologist  who  is  not  a  doc- 
tor of  medicine,  is  certainly  not  better  than  a  church 
clinic.  I  cannot  even  acknowledge  the  right  of  psy- 
chologists to  make  hypnotic  experiments  merely  for 
the  psychological  experiment's  sake.  Nobody  ought 
to  be  brought  into  a  hypnotic  or  otherwise  abnormal 
state  of  mind  if  it  is  not  suggested  by  the  interests  of 
the  subject  himself.  Science  has  the  right  to  make 
hypnotic  experiments,  or  experiments  with  abnormal 
mental  states,  only  under  the  one  condition  that  a 
physician  has  hypnotized  the  subject  in  the  interests 
of  his  health  and  that  the  patient  has  agreed  before- 


AND  THE  COMMUNITY  381 

hand  to  allow  in  the  presence  of  witnesses  certain 
psychological  studies.  Needless  to  say  that  any  hyp- 
notization  for  mere  amusement  and  as  a  parlor  trick 
ought  to  be  considered  as  criminal. 

On  some  other  objections  which  interest  the  com- 
munity as  such  we  had  to  touch  before,  and  there  is 
no  need  of  returning  to  them  with  any  fullness  of 
argument.  We  spoke  of  the  danger  which  the  mental 
cures  carry  with  them  when  they  are  based  on  any 
particular  creed,  and  especially  when  they  are 
tied  up  with  a  semi-religious  arbitrary  metaphysics. 
What  is  gained  if  some  nervous  disorders  are  helped 
by  belief,  if  the  belief  itself  devastates  our  intellect- 
ual culture  and  brings  the  masses  down  again  to  a 
view  of  the  world  which  has  all  the  earmarks  of 
barbarism?  That  is  indeed  one  of  the  central 
dangers  of  all  non-medical  suggestive  cures,  that 
while  any  belief  may  cure  through  the  mere  emo- 
tional power  of  the  act  of  believing,  the  content  of 
the  belief  gains  an  undeserved  appearance  of  truth. 
Any  absurd  superstition  can  become  accredited  be- 
cause its  curative  value  may  be  equal  to  a  truly  valu- 
able suggestion.  The  intellectual  life  of  the  com- 
munity would  have  to  suffer  greatly  if  the  way  to  be 
freed  from  bodily  suffering  had  to  be  the  belief  in 
the  metaphysical  doctrines  of  Mrs.  Eddy's  "  Science 
and  Health."  From  a  cultural  viewpoint,  too,  sug- 
gestive therapeutics  must  stand  the  higher,  the  more 
sharply  it  is  separated  from  special  philosophical  or 
religious  doctrines.  No  theory  of  the  world  and  of 
God  ought  to  gain  authority  over  the  mind  from  such 


382  PSYCHOTHERAPYi 

an  external  motive  as  a  belief  in  its  curative  effects. 
Freest  from  such  implications  is  certainly  the  hypnotic 
method  of  the  physician  who  does  not  need  the  strong 
religious  reinforcement  of  the  suggestion  because  he 
reenforces  instead  the  suggestibility  of  the  patient  by 
slight  influences  on  his  senses. 

Even  where  sound  religion  without  superstition  and 
without  pseudophilosophy  stands  behind  the  therapeu- 
tic work,  the  community  will  not  give  up  the  ques- 
tion whether  the  church  does  not  necessarily  neglect 
by  it  the  interests  which  are  superior.  The  commu- 
nity becomes  more  and  more  strongly  aware  that  too 
many  factors  of  our  modern  society  urge  the  church 
to  undertake  non-religious  work.  Social  aid  and 
charity  work  ought  to  be  filled  with  religious  spirit, 
but  to  perform  it  is  not  itself  religion.  Still  more 
that  is  true  of  the  healing  of  the  sick.  Whether  or 
not  such  expansion  of  church  activity  in  different  di- 
rections saps  the  vital  strength  of  religion  itself  is 
indeed  a  problem  for  the  whole  community.  The 
fear  suggests  itself  that  the  spiritual  achievement 
may  become  hampered,  that  in  the  competition  of 
the  church  with  the  other  agencies  of  social  life  the 
particular  church  task  may  be  pushed  to  the  back- 
ground, and  that  thus  the  church  in  imitating  that 
which  others  can  do  just  as  well  or  better  loses  the 
power  to  do  that  which  the  church  alone  can  do. 
The  final  outcome  is  therefore  practically  in  every 
way  the  same.  From  whatever  starting  point  we 
may  come,  we  are  led  to  the  conviction  that  the 
physician  alone  is  called  to  administer  psychothera- 


AND  THE  COMMUNITY  383 

peutic  work,  but  that  he  needs  a  thorough  psycho- 
logical training  besides  his  medical  one. 

But  the  interest  of  the  community  is  not  only  a 
negative  one.  Society  does  not  only  ask  where  psy- 
chical treatment  can  be  dangerous,  but  asks  with  not 
less  right  whether  the  scheme  and  the  method  might 
not  be  fructified  for  other  social  ends  besides  the  mere 
healing  of  the  sick.  If  psychotherapy  demonstrates 
that  for  instance  hypnotism  makes  possible  the  re- 
shaping of  a  pathological  mind,  it  is  a  natural 
thought  to  use  the  same  power  for  remodeling  per- 
haps the  lazy  or  the  intemperate,  the  careless  or  the 
inattentive,  the  dishonest  or  the  criminal  mind. 
Both  educators  and  criminologists  have  indeed  often 
raised  such  questions,  and  social  reformers  have  not 
seldom  seen  there  wide  perspectives  for  social  move- 
ments in  future  times. 

There  can  be  no  doubt  that  the  possibility  of  such 
remodeling  activity  is  given,  but  as  far  as  education 
is  concerned  certainly  grave  misgivings  ought  to  be 
felt.  When  we  spoke  of  the  treatment  of  the  sick, 
we  had  always  to  emphasize  that  the  suggestion  cures 
symptoms  but  not  diseases.  In  the  same  way  hyp- 
notic suggestion  might  reenforce  a  single  trait  but 
would  not  reform  the  personality  of  the  child.  Yes, 
the  artificial  reinforcement  of  such  special  features 
would  deprive  education  of  that  which  is  the  most 
essential,  namely,  the  development  of  the  power  to 
overcome  difficulties  by  own  energy.  Wherever  a 
reasonable  amount  of  own  will  force  and  attention 
can  be  expected  to  overcome  the  antagonistic  influ- 


3  84  PSYCHOTHERAPY; 

ence,  there  artificial  hypnotic  influence  ought  to  be 
avoided.  Everything  ought  to  be  left  in  that  case  to 
suggestions  within  normal  limits,  in  the  form  of  good 
example  and  persuasions,  authority  and  discipline, 
love  and  sympathy.  That  holds  true  even  for  very 
slight  abnormalities  which  seem  still  within  the  limits 
where  the  own  energies  can  bring  about  the  cure. 
For  instance,  I  have  steadily  refused  requests  of  stu- 
dents and  others  to  use  hypnotism  for  the  purpose  of 
overcoming  merely  bad  habits,  such  as  the  habit  of 
biting  the  nails.  A  child  who  finds  some  difficulty 
in  sticking  seriously  to  his  tasks  might  learn  now  this 
and  now  that  under  the  influence  of  hypnotic  sug- 
gestions but  he  would  remain  entirely  untrained  for 
mastering  the  next  lesson.  In  the  same  way  some 
naughty  traits  might  be  artificially  removed  but  the 
child  would  not  gain  anything  towards  the  much 
more  important  power  of  suppressing  an  ugly 
tendency  by  his  own  effort.  All  that  finds  its  limits 
where  the  inhibitions  or  obstacles  in  the  brain  of  the 
child  are  too  strong  possibly  to  be  overcome  by  the 
own  good  will,  but  in  that  case  we  already  stand  in 
the  field  of  abnormal  mental  life  and  then  of  course 
psychotherapy  has  its  right.  The  feeble-minded  and 
the  retarded  child,  the  perverse  child  and  the  emo- 
tionally unstable  child,  belong  under  the  care  of  the 
physician,  and  in  such  a  case  he  ought  not  to  hesitate 
to  use  the  whole  supply  of  psychotherapeutic 
methods  which  are  at  his  disposal. 

Still  more  complex  is  the  criminological  problem. 
It  sounds  like  an  easy  remedy  for  the  greatest  social 


AND  THE  COMMUNITY  385 

calamity,  if  it  is  proposed  simply  to  hypnotize  the 
criminal  and  to  supplant  his  antisocial  will  by  a 
moral  one.  And  if  the  absurdity  of  such  a  proposal 
is  recognized  it  seems  to  many  justified  to  demand 
such  an  intrusion  at  least  in  the  case  of  the  born 
criminal,  even  if  the  occasional  criminal  cannot  be 
reached.  But  the  conception  of  the  born  criminal  is 
also  only  a  label  which  is  superficially  used  for  a 
great  variety  of  minds.  That  men  are  born  with  a 
brain  which  necessarily  produces  criminal  actions  is 
not  indicated  by  any  facts.  The  varieties  which  na- 
ture really  produces  are  brains  which  are  more  liable 
than  others  to  produce  antisocial  actions.  We  recog- 
nized from  the  start  that  the  abnormal  mind  never 
introduces  any  new  elements  but  is  characterized  only 
by  a  change  of  proportions.  There  is  too  much  or 
too  little  of  a  certain  mental  process  and  just  for  that 
reason  there  must  be  a  steady  and  continuous  transi- 
tion from  the  normal  to  the  entirely  abnormal.  Here 
again  we  have  not  a  special  class  of  brains  which 
are  criminal;  but  we  have  an  endless  variety  of  brains 
with  a  greater  or  smaller  predisposition  for  antisocial 
outbreaks.  The  variations  which  produce  this  crim- 
inal effect  may  lie  in  most  different  directions. 

The  brain  may  be  for  instance  inclined  to  over- 
strong  impulses,  so  that  any  desire  rushes  to  action 
before  the  inhibiting  counter-idea  gets  to  work.  Or, 
on  the  other  hand,  the  brain  may  have  unusually 
weak  counter-ideas  so  that  even  a  normal  impulse 
does  not  find  its  normal  checking.  The  fact  that 
selfish  and  thus  antisocial  desires  awake  in  the  mind 


3  86  PSYCHOTHERAPY 

is  not  abnormal  at  all;  only  if  they  are  not  normally 
inhibited,  the  disturbance  sets  in.  Furthermore  the 
associative  apparatus  of  the  brain  may  work  espe- 
cially slowly;  it  may  thus  bring  it  about  that  the 
counteracting  ideas  do  not  arise  in  time.  Or  the  emo- 
tions of  a  person  may  be  unusually  strong.  Or  there 
may  be  strong  suggestibility,  by  which  a  bad  example 
or  a  strong  temptation  has  especially  easy  access.  Or 
there  may  be  negative  suggestibility,  by  which  a  moral 
admonition  stirs  up  a  vivid  idea  of  the  opposite.  In 
short,  there  may  be  a  large  number  of  factors,  some- 
times even  in  combination,  each  one  of  which  increases 
the  chances  that  the  individual  may  come  in  danger 
in  the  midst  of  developed  society.  Yet  no  one  of 
those  factors  involves  just  the  necessity  of  crime. 
The  same  kinds  of  brains  might  simply  show  stupid- 
ity or  credulity  or  inconsiderateness  or  brutality  or 
stubbornness  or  egotism,  and  might  by  each  of  those 
factors  decrease  their  chances  in  the  community  with- 
out directly  running  into  conflict  with  the  law.  The 
criminal  is  therefore  never  born  as  such.  He  is  only 
born  with  a  brain  which  is  in  some  directions  in- 
efficient and  which  thus,  under  certain  unfavorable 
conditions,  will  more  easily  come  to  criminal  deeds 
than  the  normal  brain. 

With  the  idea  of  a  stereotyped  born  criminal  there 
disappears  also  the  idea  of  a  uniform  treatment 
against  criminal  tendencies.  That  men  are  different 
in  their  power  of  resistance  or  in  their  power  of  ef- 
ficiency or  in  their  intellect  or  in  their  emotions,  we 
have  to  accept  as  the  fundamental  condition  with 


AND  THE  COMMUNITY  387 

which  every  society  starts.  It  would  be  absurd  to 
remodel  them  artificially  after  a  pattern.  The  result 
would  be  without  value  anyhow,  inasmuch  as  our  ap- 
preciation is  relative.  No  character  is  perfect. 
The  more  the  differences  were  reduced,  the  more  we 
should  become  sensitive  even  for  the  smaller  varia- 
tions. All  that  society  can  do  is,  therefore,  not  to  re- 
model the  manifoldness  of  brains,  but  to  shape  the 
conditions  of  life  in  such  a  way  that  the  weak  and  un- 
stable brains  also  have  a  greater  chance  to  live  their 
lives  without  conflicts  with  the  community. 

The  situation  is  different  as  soon  as  the  particular 
surroundings  have  brought  it  about  that  such  a  brain 
with  reduced  powers  has  entered  a  criminal  career. 
The  thought  of  crime  now  becomes  a  sort  of  obses- 
sion or  rather  an  autosuggestion.  The  way  to  this 
idea  has  become  a  path  of  least  resistance,  and  as  soon 
as  such  an  unfortunate  situation  has  settled  itself,  the 
chances  are  overwhelming  that  a  criminal  career  has 
been  started.  If  such  cases  should  come  early  to 
suggestive  treatment  which  really  would  close  the 
channels  of  the  antisocial  autosuggestion,  much  harm 
might  be  averted.  Yet  again  the  liability  of  the 
brain  to  become  antisocial  would  not  have  been  re- 
moved, and  thus  not  much  would  be  secured  unless 
such  a  person  after  the  treatment  could  be  kept  under 
favorable  conditons.  With  young  boys  who  through 
unfortunate  influence  have  caught  a  tendency,  for  in- 
stance, to  steal,  and  where  the  fault  does  not  yield 
to  sympathetic  reasoning  and  to  punishment,  an  early 
hypnotic  treatment  might  certainly  be  tried.  I  my- 


388  PSYCHOTHERAPY 

self  have  seen  promising  results.  But  if  the  impulse 
has  irresistible  character  in  such  a  way  that  the  good 
will  is  powerless,  we  are  again  in  the  field  of  disease 
and  the  point  of  view  of  the  physician  has  to  be 
substituted  for  that  of  the  criminologist. 

Whether  pedagogy  and  criminology  are  to  make 
use  of  the  services  of  psychotherapy  is  thus  certainly 
an  open  question.  It  would  be  short-sighted  to  over- 
look the  serious  obstacles  which  stand  in  the  way. 
But  while  the  social  life  outside  of  the  circle  of  real 
disease  may  better  go  on  without  direct  interference 
by  psychotherapeutic  influences,  it  is  certainly  the 
duty  of  the  community  to  make  the  underlying  prin- 
ciples of  psychotherapy  useful  for  the  sound  develop- 
ment of  society.  The  artificial  over-suggestions 
which  are  needed  to  overcome  the  pathological  dis- 
turbances of  mental  equilibrium  may  be  left  for  the 
cases  of  illness.  But  we  saw  that  every  mental 
symptom  of  disease  was  only  an  exaggeration  of  ab- 
normal variations  which  occurred  within  the  limit  of 
health.  To  reduce  these  abnormalities  means  to  se- 
cure a  more  stable  equilibrium  and  thus  to  avoid 
social  damages,  and  at  the  same  time  to  prevent  the 
growth  of  the  abnormality  to  pathological  dimen- 
sions. To  counteract  these  slighter  variations,  these 
abnormalities  which  have  not  yet  reached  the  degree 
of  disease,  will  demand  the  same  principles  of  treat- 
ment, only  in  a  weaker  form.  It  is  in  a  way  not  psy- 
chical therapy  but  psychical  hygiene.  And  this  is  no 
longer  confined  to  the  physician  but  must  be  intrusted 
to  all  organs  of  the  community.  And  here  more 


AND  THE  COMMUNITY  389 

than  in  the  case  of  disease,  the  causal  point  of  view 
of  the  physician  ought  to  be  brought  into  harmony 
with  the  purposive  view  of  the  social  reformer,  of 
the  educator  and  of  the  moralist. 

The  ideal  of  such  mental  hygiene  is  the  complete 
equilibrium  of  all  mental  energies  together  with  their 
fullest  possible  development.  To  work  towards  this 
end  does  not  mean  to  aim  towards  the  impossible  and 
undesirable  end  of  making  all  men  alike,  but  to  give 
to  all,  in  spite  of  the  differences  which  nature  and  so- 
ciety condition,  the  greatest  possible  inner  complete- 
ness and  outer  usefulness.  The  efforts  in  that  direc- 
tion have  to  begin  with  the  earliest  infancy  and  are 
at  no  age  to  be  considered  as  finished;  the  whole 
school  work  and  to  a  high  degree  the  professional 
work  has  to  be  subordinated  to  such  endeavor.  So- 
ciety has  further  to  take  care  that  those  spheres  of 
life  which  stand  less  under  systematic  principles,  such 
as  the  home  life  of  the  child  and  the  social  life  of  the 
man,  his  family  life  and  his  public  life,  are  steadily 
under  the  pressure  of  influences  which  urge  in  the 
same  direction. 

Harmonious  development  without  one-sidedness, 
and  yet  with  full  justice  to  the  individual  talents  and 
equipments,  should  be  secured.  That  means  from 
the  start  an  effort  to  secure  balance  between  general 
education  and  particular  development.  The  latter 
has  to  strengthen  those  powers  by  which  the  boy  or 
girl  by  special  natural  fitness  promises  to  be  especially 
efficient  and  happy.  It  has  to  be  supplemented  later 
by  a  wise  and  deliberate  choice  of  such  a  vocation  as 


390  PSYCHOTHERAPY 

brings  these  particular  abilities  most  strongly  to  a 
focus.  Yet  this  alone  would  mean  a  one-sidedness 
in  which  the  equilibrium  would  be  lost.  More  im- 
portant, it  would  leave  undeveloped  that  power  which 
the  youth  especially  needs  to  acquire  by  serious  edu- 
cation, the  power  to  master  what  does  not  appeal  to 
the  personal  likings  and  interests.  An  equilibrium  is 
secured  only  if  at  the  same  time  full  emphasis  is  given 
to  the  learning  and  training  in  all  which  is  the  com- 
mon ground  of  our  social  existence.  From  the  multi- 
plication table  to  the  highest  cultural  studies  in  col- 
lege, the  youth  is  to  be  adjusted  to  the  material  of 
our  civilization  without  any  concession  to  the  emascu- 
lating desire  to  adjust  civilization  simply  to  the  par- 
ticular youth.  He  has  to  learn  learning  and  not 
only  to  play  with  knowledge,  he  has  to  learn  to 
force  his  attention  in  adjustment  to  those  factors  of 
civilization  which  are  foreign  to  his  personal  tend- 
encies and  perhaps  unsympathetic.  Free  election 
of  life's  work  and  unyielding  mental  discipline  in 
the  service  of  the  common  demands  should  thus 
steadily  cooperate.  The  one  without  the  other 
creates  a  lack  of  mental  balance  which  is  the  most 
favorable  condition  for  a  pathological  disturbance. 

The  mere  learning  is  of  course  on  both  sides  only 
a  fraction  of  what  the  community  has  to  develop  in 
the  youth.  Mental  hygiene  begins  with  physiolog- 
ical hygiene.  The  nourishment  of  the  child,  the  care 
'for  the  child's  sense  organs,  the  recesses  and  the  rest 
'from  fatigue,  and  especially  the  undisturbed  sleep 
are  essential  conditions.  The  interferences  with  suf- 


AND  THE  COMMUNITY  391 

fkient  sleep  are  to  a  high  degree  responsible  for  the 
later  disturbances  of  the  mental  life.  It  must  not 
be  forgotten  that  the  decomposition  of  the  brain 
molecules  can  never  be  restituted  by  anything  but  rest, 
and  ultimately  by  sleep.  Physical  exercise  is  cer- 
tainly not  such  restitution.  In  the  best  case  it  brings 
a  certain  rest  to  some  brain  centers  by  engaging  other 
brain  parts.  The  child  needs  sleep  and  fresh  air  and 
healthful  food  more  than  anything  else,  if  his  mind 
is  active.  The  careful  examination  of  the  sense 
organs  and  of  the  unhindered  breathing  through  the 
nose  is  most  important.  Even  a  slight  defect  in 
hearing  may  become  the  cause  of  an  under-develop- 
ment  of  attention. 

More  important  than  mere  physical  hygiene  is  the 
demand  that  a  sound  character  and  a  sound  tempera- 
ment are  also  to  be  built  up,  at  the  side  of  a  sound 
interest.  Here  again  everything  depends  upon  a 
wise  balance  between  the  development  of  that  which 
is  given  by  nature  to  the  particular  individual  and  the 
reenforcement  of  that  which  society  demands  and 
which  belongs  therefore  to  the  common  equipment. 
The  emotional  stability  and  emotional  enlargement 
of  the  mind  is  perhaps  most  neglected  in  our  educa- 
tional schemes.  On  the  one  side  it  demands  a  sys- 
tematic discipline  of  the  emotions,  on  the  other  a 
healthy  stimulation  of  emotions.  Here  is  the  place 
where  imagination  in  play  and  later  in  art  come  in. 
The  biological  value  of  play  always  lies  in  the  train- 
ing for  the  functions  of  later  life,  and  especially  for 
the  emotional  functions.  The  play  of  our  children 


392  PSYCHOTHERAPY 

is  too  little  adjusted  to  this  task.  For  this  reason  it 
leaves  too  many  unprepared  for  the  world  of  art  and 
for  the  emotional  experiences  of  real  life.  Both  lack 
of  emotional  discipline  and  narrow  one-sidedness  of 
emotions  interfere  with  the  harmonious  development. 
Destructive  emotions  like  terror  ought  to  be  kept 
away  and  not  needlessly  brought  near  by  uncanny 
stories  and  mystic  superstitions.  It  is  the  healthy 
love  and  sympathy  of  the  home  which  contributes 
most  strongly  to  the  normal  development  of  emo- 
tions. Again  in  the  field  of  will,  we  want  the  strong, 
spontaneous,  independent  will  which  is  not  frightened 
by  discomfort  and  not  discouraged  by  obstacles,  and 
yet  we  want  the  will  which  is  not  stubborn  and  selfish 
but  which  subordinates  itself  to  the  larger  will  of  the 
social  group  and  to  the  eternal  will  of  the  norm. 
There  is  no  balance  where  independence  and  sub- 
ordination do  not  supplement  each  other.  A  wide 
education  not  only  trains  for  both  but  also  secures 
habits  which  work  as  autosuggestions  in  both  di- 
rections. 

But  all  this  harmonious  development  of  intellect 
and  temperament  and  character  has  to  go  on  when 
the  school  days  are  over  and  just  here  begins  the  duty 
of  the  community  as  a  whole.  The  special  functions 
of  the  teachers  have  to  be  taken  up  by  the  public  in- 
stitutions. The  whole  social  life  must  shape  itself  in 
such  a  way  that  everyone  finds  the  best  possible 
chances  to  perfect  this  harmonious  growth.  In  the 
field  of  the  intellect,  the  community  must  take  care 
that  thoroughness  of  training  and  accuracy  of  infor- 


AND  THE  COMMUNITY  393 

mation  is  rigidly  demanded  and  not  thrust  out  by  an 
easygoing  superficiality.  The  expert  ought  to  re- 
place the  amateur  in  every  field.  Every  society 
which  allows  successes  to  superficiality  diminishes  its 
chances  for  mental  health.  Yet  while  thoroughness 
demands  concentration  in  one  direction,  society  must 
with  the  same  earnestness  insist  on  well-rounded  gen- 
eral education  and  continuity  of  general  interests 
through  life.  Literature  and  the  libraries,  the  news- 
papers and  the  magazines  play  there  a  foremost  role, 
and  again  the  mental  health  of  the  community  has  to 
pay  the  penalty  if  its  newspapers  work  against  gen- 
eral culture.  In  the  emotional  field  art  and  music, 
fiction  and  the  theater  on  the  one  side,  the  church  on 
the  other  side,  remain  the  great  schools  for  a  develop- 
ment of  sound  emotions.  Where  literature  becomes 
trivial,  where  the  stage  becomes  degraded,  and  where 
the  church  becomes  utilitarian  and  uninspiring,  great 
powers  for  possible  good  in  emotional  education  are 
lost.  But  with  this  enrichment  of  feelings  the  dis- 
ciplinary influence  too  has  to  go  through  the  whole 
social  life.  Where  art  is  sensational  and  the  church 
hysterical, — in  short,  where  the  community  stirs  up 
overstrong  feelings, — the  wholesome  balance  is  lost 
again.  In  a  similar  way  the  public  demands  should 
throughout  stimulate  the  energy  and  ambitions  and 
initiative  of  the  man,  and  yet  should  keep  his  desires 
and  impulses  in  control. 

Few  factors  are  more  influential  in  all  these  direc- 
tions than  the  administration  of  law.  Sound  sober 
lawmaking  and  fair  judgment  in  court  secure  to  the 


394  PSYCHOTHERAPY 

community  a  feeling  of  safety  which  gives  stability 
to  emotions  and  feelings.  The  disorganization  which 
results  from  arbitrary  laws,  from  habitual  violation 
of  laws,  from  corruption  and  injustice  works  like  a 
poison  on  the  psychophysical  system.  A  similar  un- 
balancing influence  emanates  from  overstrong  con- 
trasts of  poverty  and  comfort.  A  poverty  which 
discourages  and  leaves  no  chances  and  a  wealth  which 
annihilates  the  energies  and  effaces  the  consciousness 
of  moral  equality,  create  alike  pernicious  conditions 
for  mental  balance. 

Unlimited  furthermore  are  the  influences  which 
depend  upon  the  sexual  ideas  of  the  society.  It  is 
the  sphere  in  which  it  may  be  most  difficult  to  indicate 
the  way  towards  a  development  without  dangers. 
There  is  no  doubt  the  arbitrary  suppression  of  the 
sexual  instinct  must  be  acknowledged  as  the  source 
of  nervous  injury  while  indulgence  may  lead  to  dis- 
ease and  misery.  But  in  any  case  frivolous  habits 
and  easy  divorce  contribute  much  to  the  unbalanced 
life  which  ruins  the  unstable  individual.  Not  less 
difficult  and  not  less  connected  with  the  mental  hy- 
giene is  the  alcohol  problem.  For  normal  adult  men 
mild  doses  have  through  their  power  to  relieve  the 
inhibitions  undeniable  value  for  the  sound  develop- 
ment of  the  community.  Its  intemperate  use  or  its 
use  by  young  people  and  by  pathological  persons  is 
one  of  the  gravest  dangers.  Whether  intemperance 
ought  to  be  fought  by  prohibition  or  rather  by  an 
education  to  temperance  is  a  difficult  question  in  which 
the  enthusiastic  women  and  ministers,  backed  by  the 


AND  THE  COMMUNITY  395 

well  justified  fears  of  psychiatrists,  will  hardly  be  on 
the  same  side  as  the  sober  judgment  of  scientists,  un- 
prejudiced physicians,  and  historians.  In  any  case 
the  saloon  and  its  humiliating  indecency  must  disap- 
pear and  every  temptation  to  intemperance  should  be 
removed.  Above  all,  from  early  childhood  the  self- 
control  has  to  be  strengthened,  the  child  has  to  learn 
from  the  beginning  to  know  the  limits  to  the  grati- 
fication of  his  desires  and  to  abstain  from  reckless 
over-indulgence.  With  such  a  training  later  on  even 
the  temptations  of  alcoholic  beverages  would  lose 
their  danger.  Not  less  injurious  than  the  strong 
drinks  are  the  cards.  All  gambling  from  the  child's 
play  to  the  stock  exchange  is  ruinous  for  the  psycho- 
physical  equilibrium.  The  same  is  true  of  any  over- 
use of  coffee  and  tea  and  tobacco,  and  as  a  matter  of 
course  still  more  the  habitual  use  of  the  drugs  like 
the  popular  headache  powders  and  sleeping  medi- 
cines. The  life  at  home  and  in  public  ought  to  be 
manifold  and  expansive  but  ought  to  avoid  over- 
excitement  and  over-anxiety.  A  good  conscience,  a 
congenial  home,  and  a  serious  purpose  are  after  all  the 
safest  conditions  for  a  healthy  mind,  and  the  com- 
munity works  in  preventive  psychotherapy  wherever 
it  facilitates  the  securing  of  these  three  factors. 

For  that  end  society  may  take  over  directly  from 
the  workshop  of  the  psychotherapist  quite  a  number 
of  almost  technical  methods.  Suggestion  is  one  of 
them.  The  means  of  suggestion  through  education 
and  art,  through  the  church  and  through  public  opin- 
ion, through  example  and  tradition,  and  even  through 


396  PSYCHOTHERAPY 

fashion  and  prejudices,  are  millionfold,  but  not  less 
numerous  are  the  channels  for  antisocial  and  antihy- 
gienic  suggestions.  No  one  can  measure  the  injury 
done  to  the  psychophysical  balance  of  the  weaker 
brains,  for  instance,  by  the  sensational  court  gossip 
and  reports  of  murder  trials  in  the  newspapers  for 
the  masses.  But  while  the  influence  of  suggestion  is 
on  the  whole  familiar  to  public  opinion,  the  com- 
munity is  much  less  aware  of  another  factor  which 
we  found  important  in  the  hands  of  the  psycho- 
therapist. We  recognized  that  mental  disturbances 
were  often  the  result  of  suppressed  emotion  and  re- 
pressed wishes.  For  the  cure  the  psychotherapist  has 
to  aim  toward  the  cathartic  result.  The  suppressed 
ideas  had  to  be  brought  to  consciousness  again  and 
then  to  be  discharged  through  vivid  expression.  So- 
ciety ought  to  learn  from  it  that  few  factors  are  more 
disturbing  for  the  mental  balance  than  feelings  and 
emotions  which  do  not  come  to  a  normal  expression. 
It  is  no  chance  that  in  countries  of  mixed  Protestant 
and  Catholic  civilization,  the  number  of  suicides  is 
larger  in  Protestant  regions  than  in  the  Catholic  ones 
where  the  confessional  relieves  the  suppressed  emo- 
tions of  the  masses.  This  is  also  the  most  destructive 
effect  of  social  and  legal  injustice ;  emotions  are  stran- 
gulated and  then  begin  to  work  mischief.  The  com- 
munity should  take  care  early  that  secret  feelings  are 
avoided,  that  the  child  is  cured  from  all  sullenness 
which  stores  up  the  emotion  instead  of  discharging  it. 
Certainly  all  education  and  social  life  demands  in- 
hibition and  also  the  child  has  to  learn  not  to  give  ex- 


AND  THE  COMMUNITY  397 

pression  to  every  passing  feeling.  To  find  there  the 
sound  middle  way  is  again  the  real  hygienic  ideal. 
Too  much  in  our  social  life  and  especially  in  the 
sphere  of  sexuality  forces  on  the  individual  a  hypoc- 
risy and  secrecy  which  is  among  the  most  powerful 
conditions  of  later  mental  instability. 

Of  course  the  background  of  a  hygienic  life  of  the 
community  remains  the  philosophy  of  life  which  gives 
unity  to  the  scattered  energies  and  consequently 
steadiness  to  the  individual  through  all  his  hazards  of 
fate.  It  might  seem  doubtful  whether  society  could 
get  the  prescription  for  such  a  steady  view  of  the 
world  also  from  the  workshop  of  the  psychotherapist. 
To  the  superficial  observer  the  opposite  might  seem 
evident,  as  every  word  of  our  psychotherapeutic  study 
indicated  that  that  is  a  view  of  life  which  makes 
man's  inner  experience  simply  an  effect  of  foregoing 
causes.  All  life  becomes  a  psychophysical  mechanism 
and  from  that  point  of  view  man's  thinking  and  act- 
ing become  the  necessary  outcome  of  the  foregoing 
conditions.  Nothing  seems  more  unfit  to  give  a 
deeper  meaning  to  life  and  a  higher  value.  And  yet 
if  there  was  one  thought  which  controlled  our  dis- 
cussion from  the  beginning,  it  was  certainly  the  con- 
viction that  this  causal  view  itself  is  only  an  instru- 
ment in  the  service  of  idealistic  endeavors ;  the  reality 
of  man's  life  is  the  reality  of  will  and  freedom  di- 
rected towards  ideals.  One  of  these  ideals  is  the 
reconstruction  of  the  world  in  the  thought  forms  of 
causality.  In  the  service  of  our  ideals  we  may  thus 
transform  the  world  into  a  mechanism:  out  of  our 


398  PSYCHOTHERAPY 

freedom  we  desire  to  conceive  ourselves  as  neces- 
sary products.  Whenever  we  aim  to  produce  changes 
in  the  world,  we  must  calculate  the  effects  through  the 
means  of  this  causal  construction,  but  we  never  have 
a  right  to  forget  that  this  calculation  itself  is  there- 
fore only  a  tool  and  that  our  reality,  in  which  our 
duties  and  our  real  aims  lie,  is  itself  outside  of  this 
construction.  The  psychotherapist  wants  to  produce 
effects  inasmuch  as  he  wants  to  cure  disease.  He  is 
therefore  obliged  to  adjust  his  work  as  such  entirely 
to  the  causal  aspect  of  man,  as  soon  as  he  wants  to 
seek  the  means  by  which  he  can  reach  the  end.  But 
even  the  fact  that  he  decides  in  favor  of  those  ends, 
that  he  aims  towards  their  realization,  binds  him  to  a 
world  of  purposes,  and  therefore,  he,  too,  with  his 
whole  psychophysical  work,  stands  with  both  feet  in 
a  reality  of  will  which  is  controlled  not  by  causes  but 
by  purposes,  not  by  natural  laws  but  by  ideals. 


INDEX 


Abnormal,  75 

Abstinence,  281 

Action,  34,  101,  276 

Adenoids,  189 

Adjustment,   102 

Esthetic,  63 

Alcohol,    198 

Alcoholism,  278 

Alternation,  154.  174 

Anemia,  310 

Anaesthesia,  174,  301 

Analysis,  21 

Antagonistic,  24 

Anxiety,   272 

Appeal,  93 

Applied  Psychology,  60 

Appreciation,  10 

Art,  87 

Association,   29,   32,   42 

Association     Experiment,     72, 

233,  359 

Associationism,  44 
Astrology,   350 
Assurance,  215 
Assyria,  322 
Ataxia,  179 
Atoms,  27 
Attention,  46,  95,  99,  113,  20O, 

244 

Attitudes,  13 
Authority,  222 
Automatic,   144,  237 
Autosuggestion    122,    172,    219, 

255,  266 
Awareness,  133,  149 

Beauty,  197 
Belief,  100,  329 
Blood-vessels,  302 
Blushing,  262 
Braidism,  353 
Brain,  29,  34,  67,  139 


Cancer,  178 

Cathartic,  233,  358 

Causality,   14,  32,  57 

Cell,  44,  81,  89 

China,  321 

Church,  319 

Christianity,  324 

Christian    Science,    7,   55,   317, 

327,  343.  344 
Chronoscope,  71 
Circulation,  79 
Clairvoyant,    128 
Clearness,  103 
Cocainism,  283 
Coconscipus,  156 
Communication,  22 
Community,  370 
Company,  197 
Comparative  Anatomy,  38 
Complex,  232,  249,  270 
Confidence,   221,   230 
Conscience,  219 

Consciousness,  1 1,  125,  130,  134 
Contact,  223 
Cortex,  47 
Cretinism,  168 
Crime,  112 
Criminology,  383 


Dementia,  168 

Depression,  178,  267,  314 

Description,  19 

Diabetes,   311 

Diagnosis,  66,  184,  241 

Digestive,   177,  309 

Dilettanteism,  2 

Discharge,  49,  90,  218,  232,  252, 

T.39^  ,- 
Discipline,  202 

Disposition,  138,  143 
Dissociation,  135,  153 


399 


400 


INDEX 


Dream,   114 
Drugs,    163,   334 

Education,   389 
Effort,  289 
Efficiency,  194 
Egyptians,    323 
Electrobiology,    353 
Emmanuel    Church,    326,    328, 

33i,  34i 
Emotion,  88,  123,  235,  259,  314, 

392 

Encouragement,  206 
Energy,  276,  288 
Epidemic,    193 
Epilepsy,  80,  207 
Equilibrium,  160 
Ergograph,  71 
Ethics,  1 6 
Ethnology,  329 
Examination,  186 
Exhaustion,  196 
Experimental  Psychology,  5,  61 
Explanation,  19,  28,  41 

Faith,   6,   335 
Fascination,   116,  230 
Fear,  172,  259,  263 
Feeble-minded,  72,  295 
Feelings,  23 
Freedom,  51,  146 
Functional  Diseases,  81,  343 

Galvanoscope,  71 
Genetic  Psychology,  39 
Gospels,  324 
Greeks,  323,  350 

Half-sleep,   226 
Hallucination,  246 
Hastiness,    200 
Headache,  309 
Hearing,  300 
Heart  Disease,  310 
Heterosuggestion,    122 
History,   16 
Hygiene,  389 
Hypnoid,   116,  227 
Hypnotism,    74,    85,    109,    122, 

227,    243,    350 
Hysteria,  122,  174,  269,  356 


Idealism,   2,   33'  397 

Illness,  67 

Imagination,  in 

Impulse,   89 

Improvement,  299 

Indecision,  290 

Indians,  321 

Inherited,   171 

Inhibition,  86,  95,  113,  295,  305, 

315 

Insanity,    165,  256 
Insomnia,  303,  312 
Instinct,  305 
Intemperance,  281 
Intensity,    194 
Interruption,  191 

Japan,   322 
Jews,  322 

Kymograph,  71 
Knowledge,  II 

Lawyer,  87 
Learning,   390 

Magnetism,  351 
Make-believe,  216 
Memory,  138 
Mesmerism,  128,  253 
Minister,  57,  207,  332,  340,  367 
Monotony,  203 
Moral,     5,   84 
Morality,  372 
Morphinism,  283,  376 
Motor  Process,  46,  07,  218 
Movement  Sensation^  24 
Mystic,  224,  315 

Naturalism,  4 
Negativism,  220 
Nervousness,  193 
Neurasthenia,  169,  246,  290,  292 
Neuron,  164 
Nutrition,  79,  312 

Obedience,  201 
Object,  13,  18 
Obsession,  246 


INDEX 


401 


Opposite  Idea,  97 
Oppression,  272 
Organic  Diseases,  81,  343 
Organism,  23 

Pain,  69,  167,  298,  309,  313,  342 

Parallelism,  33,  37,  40 

Passes,  117 

Pathology,  36 

Pauses,    190 

Pedagogy,  63 

Perception,  20,  34,  133 

Personality,  n,  25,  154 

Persuasion,  214 

Perversity,   176 

Phobia,    94 

Physical,  18 

Physician,  57,  347 

Physicotherapy,  I 

Pneumograph,  71,  235 

Poet,  59 

Posthypnotic,    120,    231 

Postulate,   41 

Prayer,  207 

Prohibition,  198 

Protestantism,  325 

Psychasthenia,  172,  264,  277 

Psychiatry,  70 

Psychical,  18 

Psychoanalytic,  236,  272 

Psychological     Laboratory,     S» 

36,  60,  72,  356 

Psychology,  5,  8,  25,  39,  364 
Pulse,  235,  294 
Purposes,    n,    17 
Purposive,  13,  33,  65,  145,  338 

Reactions,  50,  143 
Realism,  2 
Reality,    15 
Reasoning,  212 
Recklessness,   201 
Recuperation,    191 
Relapse,  281 
Relativity,  195 
Religion,  84,  207,  329,  341 


Reparable,   165 
Reservoir,  209 
Resistance,  105 
Rest,    191 

Retardation,    169,  202 
Revival,  337 

Savages,  320 
Secrets,  185 
Self,  24,  131 
Self-consciousness,  136 
Sensation,  22,  28 
Sense  Organ,  300 
Shamanism,  320 
Sidetracking,  236,  249,  271 
Sleep,  112,  177,  226,  303,  307 
Somnambulism,    114,    153,   352 
Sphygmograph,  71,  235 
Stammering,  175,  274 
Stomach,  309 
Subconscious,    125,    161 
Subcortical,    143,    306 
Subject,  13 

Suggestibility,  88,  107,  221 
Suggc?tion,    85,    loo,   213,   273, 

395 

Superficiality,    200 
Supervision,  279 
Surroundings,  189 
Sympathy,   205 
Symptoms,   80,    186 

Temperance,    198 
Tones,  44 
Toxic,   167 

Unity,  52,  135 

Vacation,  197 
Vividness,  50 

Will,  n,  31 
Witness,  107 
Worry,  259 

Yogi,  350 


Date  Due 


FEB2J 


1984 


PRINTED  IN   U.S.A.  CAT.     NO.     24     161 


3  1970  00381    4677 


A    000  420  055     6 


I4iinsterberg,   Hugo, 
Psychotherapy . 


